Archived: Mayfield House Residential Home

Mayfield House is a residential care home providing personal care to 22 people aged 65 and over including people living with dementia at the time of the inspection. The service can support up to 34 people.

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

Allegations of abuse had not always been reported to the local authority and due consideration had not always been given to possible risks when recruiting new staff. People told us they felt safe living at the home and they received their medicines in a safe way. Necessary improvements had been made to ensure there were robust infection prevention and control procedures and thorough health and safety checks were taking place on equipment and the environment.

People's care needs had been assessed and staff had received appropriate training so they knew how best to provide people’s care. People enjoyed their meals and were supported to maintain a healthy weight. Where needed health care professionals had been contacted for direct care or support.

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 told us they enjoyed living at Mayfield House and liked the staff who supported them. People were treated kindly, promoted to be independent, and had their privacy and dignity protected.

Necessary improvements had been made to care plans which detailed people's care needs and staff used these to provide the right care and support. People were able to do the things they enjoyed and were supported to have contact with people who were important to them.

There had been improvements made to management oversight at the home however further improvement to management systems was required. The home worked well with other professionals to improve people’s care. People using the service, visitors and staff spoke positively about the registered manager. They felt able to discuss any concerns and felt these would be investigated and addressed.

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 15 October 2020) and there were multiple 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 improvements had been made and the provider was no longer in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Mayfield House provides care and accommodation for up to 34 people, some have physical needs and some people are living with dementia. On the day of our inspection 25 people were living at the service.

People’s experience of using this service:

Where risks associated with people’s care were identified there was not always appropriate guidance in place in relation to this. Incidents of behaviour were not always recorded appropriately in order for the registered manager to investigate and analyse. The service was not cleaned effectively, and appropriate infection control measures were not always being undertaken.

There were audits taking place, however these were not always robust particularly around the monitoring of infection control.

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 requires improvement (published 15 August 2019) and there were multiple breaches of regulation. At that inspection we identified continued breaches in relation to the safety of people’s care, and the lack of robust quality assurances at the service.

Why we inspected:

We undertook a targeted inspection due to concerns we received that related to incidents where people were put at risk, and to review the progress made by the service to become compliant with the multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This report only covers findings in relation to risk associated with people’s care and quality assurance. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement:

We have identified continued breaches in relation to the safety of care provided and the quality assurance of the service. 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

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 continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner. We will continue to work with the local authority to monitor progress.

Mayfield House is a residential care home that was providing personal care to 18 older people with physical disabilities and mental health conditions at the time of the inspection. The service is registered to provide support to up to 34 people and care is provided in one adapted building.

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

People told us they felt safe and there had been improvements to plans about risks, but we found continued inconsistencies in how risks were documented and responded to. This inspection found improvements had been made in some areas, but improvements were not consistent enough to ensure all the legal requirements had been met. This showed action plans shared with CQC had not yet been implemented robustly.

People’s care plans had been updated with improved detail but in some areas more work was required to ensure these reflected people’s personalised needs and preferences. The provider had introduced increased activities but people’s feedback showed they had not yet fully experienced the positive impact of these improvements.

People were supported in line with the Mental Capacity Act 2005. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Where people had restrictions placed upon them, the correct legal process had been followed. Records relating to people’s healthcare appointments had improved and people received check-ups when required. Records relating to medicines had sufficient detail within them to inform staff about how and when to administer them.

Work had been carried out to improve staff practice so people’s dignity was maintained. We made positive observations of staff practice but work was still in progress to gather information about people’s religion, culture, sexuality and gender identity. People were supported to be independent and staff provided care that was respectful of people’s privacy and dignity.

The home environment was improved and people’s rooms were clean. We identified minor shortfalls in furniture which audits and governance had not yet picked up. There had been an increase in the numbers of audits but our findings showed these were not yet robust enough to proactively address shortfalls found on inspection. People knew how to complain and where issues had been raised, action was taken to address the concerns. There were meetings and surveys to involve people, relatives and staff in the running of the service.

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 13 February 2019) and there were multiple 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 improvements in some areas but the provider was still in breach of some regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Following the last inspection, we met with the provider and asked the provider to complete an action plan to show what they would do and by when to improve all five key questions to at least good. There had been ongoing meetings with the local authority and the provider submitted weekly action plans to CQC. Our findings at this inspection showed that whilst action had been taken to address individual issues, there were continued breaches of the legal requirements of the regulations.

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.

Mayfield House accommodates up to 34 people in one adapted building. The service supports older people who have physical conditions and require support with mobility. The majority of people at the home were living with dementia. At the time of our visit, there were 19 people living at the service.

There was a registered manager in post. 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 not always protected from avoidable harm because known risks had not always been assessed and the plans to reduce risk were not always implemented robustly. The home environment lacked cleanliness and people’s rooms and equipment were not always in a safe condition. We had urgent concerns with some maintenance issues with the home environment and asked the provider to take immediate action to keep people safe, these urgent concerns had been addressed by the second day of our inspection.

People’s medicines were managed safely but there was a lack of information about ‘as required’ medicines in people’s records. People’s healthcare needs had not always been met. We found continued shortfalls in how people’s healthcare appointments were tracked and found instances where changes to people’s health had not been responded to robustly.

People’s legal rights were not protected because staff did not always follow the process outlined in the Mental Capacity Act 2005 (MCA). Restrictions had been placed on people without consent and the registered manager lacked understanding of how to apply the MCA. Best practice had not always been followed for people living with dementia and the home environment was not always suited to people’s needs. Staff lacked knowledge and understanding and systems to track training were not in place. We received negative feedback about the food and staff did not always have the right training to meet people’s nutritional needs.

People did not always receive dignified care because they lived in an unclean and malodourous environment. We identified instances where people’s personal hygiene needs had not been met which impacted on their dignity. People told us that staff regularly entered their rooms without knocking and there was a lack of involvement of people in their care.

There was a continued lack of opportunities for people to go out in the community and people told us they felt bored by the activities on offer. Care plans were not personalised and were written in identical ways, we found instances where important information about people’s needs were missing. There was a lack of information about people’s wishes regarding end of life care. There was a complaints policy in place but people did not feel their complaints would be addressed if they raised them.

We received mixed feedback about the management at the service. The provider’s own checks and audits had not identified and addressed the concerns we found and the action plan drawn up following our last inspection had not been effective. We found instances where records were not up to date and did not reflect care delivery.

Staff understood their roles in safeguarding people from abuse and there was a record of incidents which was monitored by management. There were enough staff deployed to meet people’s needs but there was information missing from recruitment checks for new staff. We observed some pleasant interactions and there was information in care plans about how to encourage people to maintain skills and independence. Staff felt supported by management and we saw some evidence of work with stakeholders and the community.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action 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. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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.

Mayfield House accommodates up to 34 people in one adapted building. The service supports older people who have physical conditions and require support with mobility. The majority of people at the home were living with dementia. At the time of our visit, there were 20 people living at the home.

There was not a registered manager in post, the manager of the home was in the process of registering with CQC. 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.

The provider had failed to sustain improvements at the service. After our last inspection, we noted improvements had been made and the service came out of special measures. However, these improvements had not been embedded and by the time of this inspection there had been two changes in management in the last 12 months. We also found that there was a lack of governance and record keeping at the service. We identified risks to people that had not been assessed and there was no guidance for staff on how to support them safely. Information about people’s needs and what was important to them was inconsistent and inaccurate. There was no analysis of incidents or complaints which showed there was not a proactive approach to identifying and responding to concerns or risks.

Shortfalls in the maintenance of the home environment meant that people were not always protected from the risk of the spread of infection. We identified bathroom and toilet areas in which a lack of repairs meant rooms could not be properly cleaned and equipment was stored within these environments which heightened the risk of it becoming contaminated. The provider’s audits and checks had failed to identify or address these issues. We identified odours in areas of the home that meant people did not always live in a home environment that provided dignity. We also found times where the home environment did not effectively support people living with dementia.

People were not always supported to access healthcare professionals. We identified instances where people had not attended planned appointments and there was no evidence of staff taking action in response to this. We also identified clinical risks not being monitored and a lack of guidance for staff where people were living with diabetes. We identified inaccuracies in medicines recording and management that meant people did not always receive their medicines safely.

People’s consent was not always sought in line with current legislation. Staff did not always correctly follow the Mental Capacity Act 2005 (MCA) when placing restrictions upon people. We observed staff not always being respectful of people’s privacy and people were not always involved in their care. There was a lack of variety of activities and outings for people to take part in. Information on how people could raise a complaint was not accurate and the provider did not have a system to track and monitor verbal complaints. We made a recommendation about complaints.

There were enough staff at the home to respond to people’s needs and appropriate checks had been undertaken on new staff to ensure that they were suited to their roles. Staff completed training before working with people and this was regularly refreshed. Staff were knowledgeable about safeguarding adults and knew how to raise any concerns that they had. Staff had regular meetings as well as handovers to enable them to communicate together effectively. People spoke positively about the food on offer to them but we did find instances that people’s food preferences were not documented. We made a recommendation about menu planning.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action 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. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Mayfield House is a residential care home providing support to up to 34 older people. At the time of our inspection there were 14 people living at the home. Some people at the home were living with dementia.

There was not a registered manager in post. A new manager was in the process of registering at the time of our inspection. 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.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Although further improvements are required, this service is out of Special Measures. We will continue to monitor and inspect the service for continued improvements.

At our last inspection we found breaches of regulation. At this inspection we found that most improvements had been implemented. However, we did find one continued breach of regulation.

People’s rights were not protected because the provider had not followed the guidance of the Mental Capacity Act (2005). Staff training in this area was not effective as staff were unable to say how the process applied to their work.

Improvements had been made to records but some information around risks to people was not in place at the time of inspection. We recommend that the provider regularly reviews their records, particularly in relation to risk assessments and that these are maintained accurately at all times.

People lived in a clean and safe home environment. The provider had implemented improvements to the home and kept it clean and well maintained. Robust audits had been introduced to ensure the home remained clean and where maintenance work was required, this was actioned by management.

Risks to people were managed safely. Staff took action to reduce risks to people and where appropriate, made referrals to healthcare professionals. The provider was in the process of introducing new risk assessment forms at the time of inspection. Where incidents occurred, plans were put in place to prevent them from happening again.

People’s medicines were managed and administered safely. The provider had introduced new storage and medicine management systems, with regular audits in place. People received their medicines as prescribed and in line with their wishes.

People’s care plans were person centred. Improvements had been made to the information available to staff. People’s preferences and backgrounds were clearly documented. Reviews were carried out to identify changes in people’s needs. Staff knew the people that they supported well. The provider had made improvements to the activities on offer to people. We saw evidence of people participating in activities that they enjoyed and reflected their interests.

People’s dignity was promoted by kind, respectful staff. Staff supported people in a way that promoted their privacy and dignity. People told us that they got along well with the staff. People’s independence was promoted by staff. Staff understood their role in safeguarding people from abuse and demonstrated a good knowledge of local safeguarding procedures.

The quality of people’s care was monitored and where shortfalls were identified, improvements were implemented. People benefitted from regular meetings in which they were consulted on changes at the home.

People’s nutritional needs were met by staff. People were offered choice with food and their dietary requirements were met. Staff worked alongside healthcare professionals to meet people’s needs. People knew how to complain and any complaints received were responded to with appropriate actions taken.

Staff felt supported by management and had regular supervision and training. Staff had regular meetings where they could be involved in the running of the home. There were sufficient staff in place to meet people’s needs. The provider carried out checks to ensure that staff were appropriate for their roles.

We carried out an unannounced comprehensive inspection of this service on 22 August 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. After that inspection we received concerns in relation to people’s safety and the lack of management oversight of the service. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Mayfield House Residential on our website at www.cqc.org.uk”

There was no registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Risks to people where not being managed appropriately. People were not always being moved in a safe way. Incidents and accidents to people were not being managed appropriately. Where a risk had been identified around a person’s behaviour there was not always appropriate guidance in place to reduce the risks.

People were not protected against the risk of abuse. Where safeguarding incidents had been referred to the provider appropriate action had not been taken. Not all safeguarding incidents had been referred to the CQC and the local authority.

Medicines were not managed safely and there was a risk that people did not receive their medicines when they needed. Staff competencies with medicines were not being assessed.

People were not always protected from being cared for by unsuitable staff because robust recruitment was not in place. There were gaps in the recruitment checks and there was not always evidence of why the provider felt that staff were suitable to work at the service.

The provider did not always have systems in place to regularly assess and monitor the quality of the care provided. There was a continued breach from the previous inspection around the competencies of staff and people care plans not being updated that had still not been addressed.

The provider did not have systems in place to regularly assess and monitor the quality of the care provided. There were continued breaches from the previous inspection that had still not been addressed. The provider had not actively sought, encouraged and supported people's involvement to improve the quality of care. People’s records were not always up to date or accurate.

The provider had improved the infection control practices since the last inspection and action had been taken to try to prevent the risks associated when people smoked in a garden area.

There were instances where people were receiving their medicines as prescribed and staff were signing correctly to say the person had taken them. The medicines were stored correctly.

The inspection of Mayfield House took place on 22 August 2016 and was unannounced. This inspection was to follow up on actions we had asked the provider to take to improve the service people received.

The provider was covering the registered manager’s role at Mayfield House. 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. We were informed following the inspection that the deputy manager had commenced the application process to be registered as manager with the CQC.

At our previous inspection on 13 August and 1 September 2015 we found breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action in relation to infection control, risk management, obtaining consent in accordance with the requirements of the Mental Capacity Act 2005 and assessing and monitoring the quality of the service provided. Where the regulations were not being met, the provider sent us an action plan and provided timescales by which time the regulations would be met.

During this inspection we found that some improvements had been made. However, they were not sufficient enough to meet the requirements of the regulations.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

People were not always safe because there were a number of inconsistencies in the systems and arrangements in place to protect people from harm. Robust and up to date risk assessments were not in place to identify, assess and manage risk safely to minimise the risk of harm to people.

People did not live in a safe well maintained environment. There were a number of concerns in regard to the environment that put people at risk of harm. People were at risk because there were inadequate systems and arrangements to protect people from the spread of infection. Appropriate standards of cleanliness were not being maintained. Infection control policies and procedures were in place; however it was clear staff had not followed these. We raised concerns about the conditions of chairs, commodes and toilet seats. We also raised concerns with the registered provider about the conditions of some of the bathrooms and toilets. All of these concerns placed people at risk of infection and harm.

Although there was a system to manage and report incidents, accidents and safeguarding concerns to monitor people’s safety, we could not access information about any accident or incidents that happened after April 2016. The management team did not monitor trends or identify patterns in regard to accidents or incidents.

People were not always protected from being cared for by unsuitable staff because although recruitment processes in place, they were not always followed. There were insufficient numbers of staff deployed who had the necessary skills and knowledge to meet people’s needs. The deployment of staff had an impact on the care people received.

Staff did not have a clear understanding of their responsibilities regarding the Mental Capacity Act or Deprivation of Liberty Safeguards. Where people lacked capacity they were not fully protected and best practices were not being followed.

There were inconsistencies in the care that people received; this included how staff respected people’s privacy and dignity. During our observations, we saw examples of good and poor care; staff were very busy which had an impact on the support provided. Care was not always based on individual needs, care and treatment.

People were not receiving responsive care in accordance with their needs. Where people had specific health care needs these had not been taken into account when planning the care or identifying what support they needed. There were inconsistencies in the monitoring of people’s health and support needs.

The environment was not conducive for people living with dementia, as the décor was dark, or the same colour and there was no distinction between areas of the home. This meant people may find it difficult to find their way around the home.

People had access to activities, however there were mixed feelings about the activities provided. People were not always protected from social isolation. The range of activities available was not always appropriate or stimulating for people.

The management and leadership of the home were ineffective. We were concerned about the lack of understanding or knowledge of people living at the home by the management team. This lack of knowledge meant the manager in day to day control would be unable to ensure that staff were delivering safe, effective and responsive care.

There were quality assurance systems in place to review and monitor the quality of service provided, however they were not robust or effective at identifying and correcting poor care or practices. We noted that not all relevant notifications had been received by the Care Quality Commission in a timely manner.

Medicines were managed, stored and disposed of safely. The medicines administration records (MARs) were accurate and contained no gaps or errors. However no one who had topical creams had charts completed to show that this had been administered and where. We made a recommendation that the provider ensures that body charts are completed in line with current guidelines in regard to the administration of topical creams.

People told us that they felt safe at Mayfield House. People told us, “Yes I am safe here.” Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place. Fire safety arrangements were in place to help keep people safe, except in the area people used to smoke. The service had a business contingency plan that identified how the home would function in the event of an emergency such as fire, adverse weather conditions, flooding or power cuts.

People’s preferences, likes and dislikes had been taken into consideration. People’s relatives and friends were able to visit.

People had enough to eat and drink throughout the day. Where people needed support with eating, they were supported by a member of staff.

People were supported to have access to healthcare services and healthcare professionals to support their wellbeing. The service worked effectively with health care professionals and referred people for treatment when necessary.

People told us if they had any issues they would speak to the manager. People were encouraged to voice their concerns or complaints about the service.

We found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made one recommendation to the provider. You can see what action we told the provider to take at the back of the full version of this report.

The service has a registered manager who is currently on leave. 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. The provider made interim arrangements to ensure continuity of the service during the registered manager's absence

During the inspection we spoke with people who used the service, a relative and visitors of people who used the service and from staff who worked at the service. We also spoke with a healthcare professional.

We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our review of records, observations during the inspection, speaking with three people, one relative and two visitors of people who used the service, speaking with six staff who supported the people who used the service and a healthcare professional.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

A person who used the service told us, their room was 'Nice, clean and fresh.' Another person told us, 'I'm very happy here' and showed us their room which was observed to be clean and well maintained. A relative told us, 'There has been vastly improved cleaning, now absolutely perfect...best home could wish for.'

Records showed us the provider had cleaning schedules in place carried out by cleaning staff. We also noted kitchen staff carried out deep cleaning tasks on a schedule in addition to daily cleaning. This meant risks associated with an unhygienic environment were minimised for people who used the service.

All the staff we spoke with were knowledgeable about the provider's policy regarding infection control. Records showed us staff signed when they had read the policy. Staff told us how they used personal protective equipment and the importance of hand washing and we observed staff following the policy during the inspection. A healthcare professional told us they found the home 'clean and fresh.'

Records showed us the provider's recruitment policy was followed. We found the provider obtained two references, photographic identity and carried out Disclosure and Barring Service (DBS) checks prior to staff commencing work. This meant people were supported by staff who were of good character and able to work with vulnerable adults. We noted staff received a comprehensive induction when they commenced employment and this meant people were supported by people who were competent.

Is the service effective?

People told us that they could make choices about how they spent their time. Guidelines were provided for staff in the way people preferred their care and support to be delivered. Staff communicated information about people's needs effectively and provided care and support in a consistent way.

Is the service caring?

One relative told us, 'Staff are unbelievably good...extremely conscientious...and do an immaculate job.' A healthcare professional told us, 'staff are lovely here, will ring them (community nursing service) if they have any concerns about people.'

Is the service responsive?

We observed staff interacting well with people and promoting their choice of when they received personal care, of ensuring their clothing was clean and presentable. Cleaning staff were noted to be efficient and responsive.

Is the service well-led?

The provider had schedules to monitor cleaning and maintenance work. The provider told us they held regular staff meetings to ensure staff were kept informed about their responsibilities. A maintenance person was employed to provide support to the service on a regular basis. The provider tendered for specialist work, for example, obtaining specialist quotes for a deep clean of the kitchen area in addition to its cleaning schedules. This meant the provider demonstrated some effective quality assurance monitoring. We noted the provider had made improvements to the areas identified in the previous inspection, for example, new flooring and decorating of identified areas. However, the cleaning of the laundry area was still a concern due to impeded access to the back of the operational laundry equipment. The manager told us they would ensure excess items were removed so the cleaning schedule could be carried out.

People who used the service knew they had a right to refuse consent to care. A relative told us 'They always ask my family member first.' They went onto say 'I hear staff asking her permission and giving her choices.'

We found arrangements were in place that ensured people had their nutritional needs met. A person using the service told us 'The choice is good' and added 'I can have something different if I don't like what is on the menu.'

We asked people who used the service if the home was kept clean and fresh, seven agreed with this statement, and others added comments such as 'As far as I know' and 'To the best of my knowledge.' We raised concerns about the conditions of the laundry room, the kitchen, staff toilet facilities, hand basins throughout the home, and mattresses in unoccupied rooms.

We saw that a recruitment process had been followed. This ensured that people's needs were met by staff who were appropriately qualified and experienced.

All of the people we spoke with were very happy with the service. We saw that the provider had a complaints policy and that information about how to complain was available to people in a format that met their needs.

The healthcare professional we spoke with told us 'It is a home from home here.'

During this return visit in January 2013 we did not speak with people directly on this matter, though at our previous visit in September 2012 we received a number of very positive comments when we asked about the quality of the service. One resident who had been at the home for some years told us 'I would recommend this house to anyone.' Another person who had only moved in the day before the last inspection told us they had been 'Very pleasantly surprised.'