Mayflower Court

Mayflower Court is a large residential care home providing personal care up to a maximum of 80 people. The service provides support to older people who may be living with dementia or have physical difficulties. At the time of our inspection there were 28 people using the service.

Mayflower court accommodates people across four separate units, over two floors. At the time of the inspection only the two ground floor units were being used. The building is purpose built with a central courtyard garden.

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

The management and quality assurance system had been effective at identifying concerns. However, not all these concerns had been resolved. The provider felt the appointment of a new permanent manager would ensure progress was made following a period of instability.

Medicines were not always managed safely at the home putting people at risk of harm. The provider responded in a timely manner and addressed the main areas of concern for medicines following inspection.

There was mixed response from relatives with regards to contact with the service. Improvements were needed to ensure relatives were engaged with the running of the service and reviewing of the care provided to people who used the service.

There was a high use of agency staff, but plans were in place to address this with a recruitment drive with initiatives. Staff could see the improvements with the appointment of a permanent manager and were positive about the future.

The culture within the service was positive and caring. Staff told us they worked well as a team and felt supported by the managers. Staff felt they had received the training, support and supervision they needed to undertake their roles and meet the needs of the people who used the service.

Improvements had been made since the last inspection in relation to providing people with oral health care with staff understanding their role in supporting people with this and seeing improvements in people. Care was provided in a person-centred way and people received care and treatment from health care professionals in a timely manner.

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.

Improvements were also seen in the management of infection prevention and control with the home being visibly clean and good practices in place. People using the service said, “I think it is very clean here. They clean my room every day and I get clean sheets once a week.” Staff used personal protective equipment (PPE) appropriately.

The managers were open and transparent during the inspection process and responded appropriately and responsively to issues raised.

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 inadequate (published 30 November 2021). There were breaches of regulations and conditions were imposed to the service’s registration. The provider submitted monthly action plans and audits as part of the conditions. At this inspection we found some improvements had been made but the provider remained in breach of regulations.

At our last inspection we recommended that improvements were made in person-centred care, safe care and treatment and good governance.

At this inspection we found improvements had been made in a number of the areas found at the last inspection and the conditions imposed at the last inspection had been meet. However, there were still a number of concerns identified within medicine management and the governance of the service needing further development.

This service has been in Special Measures since 30 November 2021. During this inspection due to the provider demonstrating that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service on 1 and 11 June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, person centred care and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mayflower court 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 safe care and treatment and good governance at this inspection and issued a warning notice to the provider under regulation 12(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Mayflower Court is a residential care home providing accommodation and personal care to a maximum of 80 people. This includes support for older people who may be living with dementia or have physical disabilities. At the time of the inspection the service was supporting 55 people.

Mayflower Court accommodates people across four separate units described as ‘houses’ in one large purpose-built building with a central courtyard garden.

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

Medicines were not being managed safely, which could impact on people receiving their medicines as prescribed. We found shortfalls in infection prevention and control (IPC) practice, which had deteriorated since our most recent IPC inspection carried out in January 2021. Poor standards or cleanliness and lack of adherence to COVID-19 government guidance placed people at risk of harm through infections. Although some people’s relatives had no concerns about the quality and safety of the care provided, others disclosed numerous safeguarding concerns. We were not assured there was sufficient oversight of fire safety and other potential risks. We raised our concerns with the local authority safeguarding team.

It was not demonstrated there was adequate, robust oversight of the service, and management responsibilities were unclear. Practice observed within Mayflower Court did not show a person-centred approach at senior level, as concerns relating to people’s privacy, dignity and well-being had not been identified or effectively resolved. For example, records and observations showed people did not always have access to good oral care. Lessons had not always been learned from adverse events or previous inspections by CQC or other professionals.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

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 16 July 2018). A targeted infection prevention and control (IPC) inspection was carried out by the CQC (published 14 April 2021) following an outbreak of COVID-19 at the service, where the service was inspected but not rated.

Why we inspected

We received concerns from the local authority in relation to the management of falls at Mayflower Court. As a result, we undertook a focused inspection to review the key questions of safe and well-led. We inspected and found there was a concern with person-centred care, so we widened the scope of the inspection to also include the key question of responsive.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

During the inspection we asked the provider to confirm any action taken or mitigation of risk in relation to urgent concerns we had about fire safety and medicines management. A response was provided with further information as requested.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mayflower Court on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to person centred care, safe care and treatment and good governance at this inspection.

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.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Mayflower Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

We found the following examples of good practice.

Staff were observed to be wearing Personal Protective Equipment (PPE) in line with current government guidelines. Sufficient supply of PPE was also available.

All staff and people who used the service were receiving COVID-19 testing as per government guidelines. The service was well prepared for a COVID-19 vaccination programme.

Temperatures were checked daily for all people who used the service. This ensured their wellbeing was monitored on a daily basis and the staff team could support responsively where required.

Care plans and risk assessments were in place for all people who used the service, in relation to COVID-19. These documents had been reviewed throughout the pandemic ensuring all people using the service remain safe at all times.

The service had policies and procedures supporting infection prevention and control based on the latest government guidance. Clear signage was on display on the exterior entrance to the service and wherever required internally. This ensured all visitors and staff were aware of precautions to be taken prior to entering and within the service.

The families and advocates of people who used the service were kept informed, both of individual people’s wellbeing and the status of the service regarding COVID-19.

Mayflower Court is registered to provide care for up to 80 people. The home supports older people all of whom were living with different forms of dementia. The accommodation comprised of a new purpose built building over two floors. Mayflower Court is part of the Bowthorpe Village. This includes a 'housing with care scheme' The Meadows. This is part of the Bowthorpe Village and was inspected separately and was not part of this inspection. There were 80 people living in the service at the time of our inspection visit.

Mayflower Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations. The registered manager shared that they would soon be leaving their employment with Norse Care (Services) Limited. The registered manager told us, a manager from another Norse Care Home would be transferring to Mayflower Court on a permanent basis and would be making an application to register with the Commission in due course.

At the last inspection on 16 and 17 March 2017 the service was rated 'Requires Improvement.' The report was published in June 2017. At that inspection we identified three regulatory breaches’ of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was due to the registered manager failing to ensure that people's emotional and social needs were met by staff. People were not always treated with dignity and respect. The management of the service had failed to have effective systems and processes in place to monitor and improve the safety of the service provided. We also found the service was in breach of one regulation of the Care Quality Commission (Registration) Regulations 2009. This was due to the service failing to notify us of significant incidents in a timely way.

Since our last inspection, we have continued to engage with the registered manager. We required the registered manager to complete an action plan to show what they would do and by when to improve the key questions is the service safe, effective, caring, responsive and well-led to at least good.

At this inspection, we confirmed that the registered manager and provider had taken sufficient action to address previous concerns and comply with required standards. As a result, at this inspection we found significant improvements had been made and maintained, resulting in the overall rating and each key question being changed to, ‘Good’.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected.

Suitable arrangements had been made to ensure that sufficient numbers of suitable staff were deployed in the service to support people to stay safe and meet their needs. Background checks had been completed before care staff had been appointed.

Overall medicines were managed safely and staff had a good knowledge of the medicine systems and procedures in place to support this.

People were protected by the prevention and control of infection and lessons had been learnt when things had gone wrong.

Training was provided to staff to meet the needs of people. Staff received regular supervision and appraisal and told us they felt supported in their roles.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Suitable arrangements had been made to obtain consent to care and treatment in line with legislation and guidance.

People's nutrition and hydration needs were catered for. A choice of meals were available three times a day and drinks and snacks were made readily available throughout the day.

In addition, people had been enabled to receive coordinated and person-centred care when they used or moved between different services. As part of this people had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support. Furthermore, people had benefited from the accommodation being adapted, designed and decorated in a way that met their needs and expectations.

There was an extremely positive caring culture within the service and we observed people were treated with dignity and respect. Dignity was embedded in the services' values and culture.

People's wider support needs were catered for through the provision of daily activities provided by activity coordinator, care staff and visiting entertainers.

They were also supported to express their views and be actively involved in making decisions about their care as far as possible. Confidential information was kept private.

People received personalised care that was responsive to their needs. Care staff had promoted positive outcomes for people who lived with dementia including occasions on which they became distressed.

There was a complaints policy and procedure made available to people who received a service and their relatives. All complaints were acknowledged and responded to quickly and efficiently. In addition, suitable provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

There was a positive culture in the service that was open, inclusive and focused upon achieving good outcomes for people. People benefited from there being a management framework to ensure that staff understood their responsibilities so that risks and regulatory requirements were met.

There was a range of quality audits in place completed by the management team. These were up-to-date and completed on a regular basis.

All of the people we spoke with told us they felt the service was well-led; they felt listened to and could approach management with concerns. Staff told us they enjoyed working at the service and enjoyed their jobs.

The views of people who lived in the service, relatives and staff had been gathered and acted on to shape any improvements that were made. Good team work was promoted and staff were supported to speak out if they had any concerns about people not being treated in the right way. In addition, the management team worked in partnership with other agencies to support the development of joined-up care.

Mayflower Court is registered to provide care for up to 80 people. The home supports older people all of whom were living with different forms of dementia. The accommodation comprised of a new purpose built building over two floors. Mayflower Court is part of the Bowthorpe Village. This includes a ‘housing with care scheme’ The Meadows. This is part of the Bowthorpe Village and was inspected separately and was not part of this inspection.

There was a registered manager 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. For the purposes of this report the registered manager will be referred to as the manager. When we make reference to the management team this includes the registered manager, deputy manager, and team leaders.

Mayflower Court has been open for a year this was the home’s first inspection.

At this inspection we found breaches of the Health and Care Act and registration regulations. You can see what action we asked the provider to take at the full length version of this report.

People’s medicines were not always managed in a safe way. There were some gaps with staff signing to say people had received their medicines. People’s medicines were not always stored in a safe way. The management team’s medicine monitoring systems were not always effective.

The home supported people living with dementia; however staff lacked the specialist knowledge and skills to meet these people’s needs. Staff did not react to people who expressed distress as a result of their dementia. Staff did not have adequate inductions, training, and general support from the management team and provider to support people who were living with dementia.

People were not always supported in a caring and respectful way; people who were distressed were often ignored. People where not always treated in a way which promoted their dignity and in a way which was respectful.

People were not supported to make choices with their meals and drinks. Staff did not always know what people’s likes and dislikes were. Staff did not spend time with people chatting and engaging with them, in an effort to get to know people and make their daily lives more interesting. People felt bored and sometimes felt like they did not matter. However, people were motivated and willing to engage with others when given the opportunity.

The management team was not monitoring the culture of the service. Staff received observations of their practice, however the management team had not identified that staff were not responding to people’s social and emotional needs.

The manager and the provider had not considered ways to involve the community, and seek the views of people who lived at the home and their relatives.

The management team had completed risk assessments for people at Mayflower Court and obtained information about people’s lives. Accidents and incidents were responded to in a timely way. The service had a good health infrastructure to monitor and respond to people’s health needs.

At the end of our inspection we raised the issues we found with the management team. They were receptive and open to these issues. We shortly received an action plan which identified these issues. The management team demonstrated a willingness and a commitment for the service to improve. This gave us confidence that the service would improve.