Archived: Mayfield Residential Care Home

Updated 29 June 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 14 April 2015 and was unannounced. We returned on 15 April 2015 to complete the inspection. The inspection was completed by two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we reviewed previous inspection reports and all other information we had received about the service, including notifications. Notifications are information about specific important events the service is legally required to send to us.

During the visit we spoke with four people who lived at the service and one person who was staying for the day. We spoke with five staff and the registered manager. We spoke with two people’s relatives and two health care professionals on the telephone after the inspection. We spent time observing the way staff interacted with people who use the service and looked at the records relating to support and decision making for three people. We also looked at records about the management of the service including staff recruitment and training and quality auditing.

Before our inspection, we looked at previous inspection reports and notifications we had received. Services tell us about important events relating to the care they provide using a notification. On this occasion, the registered manager was not asked to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We obtained the information that would have been provided on the PIR during the inspection.

Updated 29 June 2015

Mayfield Residential Care Home provides accommodation for up to twenty people who require personal care. At the time of our visit there were four people living at the home.

We carried out this inspection over two days on the 14 and 15 April 2015. At our last inspection in June 2014, there was no registered manager in place who was responsible for the day to day operation of the home. 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.

During our last inspection, staff were not managing people’s needs effectively and there was little staff supervision. Safeguarding was not appropriately reported and people were not involved in the running of the home. The service had a history of non-compliance. We issued compliance actions to ensure the provider made improvements. The provider sent us an action plan to show how they were going to do this.

At this inspection, improvements had been made. A registered manager was in post and present throughout the inspection. They began employment at the home as a consultant to improve people’s care plans and became the registered manager in October 2014. The registered manager had a clear action plan which detailed their vision and future plans for the service. Many of the items on the action plan had been addressed and others were in the process of completion. However, whilst changes had been made, work was needed to ensure they were embedded in practice and the improvements sustained.

Throughout our inspection, the registered manager was visible, undertaking tasks and monitoring staff. This included the administration of people’s medicines, assisting people to the table for lunch and clearing used dishes away. They reminded a member of staff to document they had applied a person’s topical cream and asked another to make sure they offered the person the opportunity to use the bathroom. Whilst the registered manager’s presence was positive in order to promote good practice, we raised concerns about the sustainability of this, especially as there were only four people using the service. The registered manager did not share this view and said it was their nature to be involved so this would not be a problem. Whilst acknowledging this, we remained concerned about the impact it would have on their overall management responsibilities. In addition, there was a risk that the standard of the service would not be maintained in the absence of the registered manager.

Improvements had been made to people’s care. People looked well supported and any resistance to support was being managed appropriately. People had up dated, comprehensive care plans in place. These detailed people’s needs, the support they required and individual preferences. All plans had been updated with the involvement of people and their families.

Risks to people’s safety such as malnutrition, pressure ulceration and falling had been appropriately assessed. However, the hot surfaces of radiators in the dining room presented a risk to people’s safety. This had been identified at a previous inspection. The provider had identified the risks but the assessments gave conflicting information. Other environmental risk assessments were in the process of further work to ensure they were more robust.

In situations where people lacked capacity to make a decision, their safety and well-being were promoted. However, necessary records of capacity assessments and best interest decisions were not always in place. Some completed assessments in relation to day to day activities and whether a person was able to go out on their own safely, lacked sufficient information. Staff had not explained and recorded the evidence for the decisions made.

Staffing levels were sufficient for the numbers of people currently living in the home. The registered manager told us they were in the process of recruiting more staff in order to accommodate new admissions. Whilst recognising the home needed higher occupancy, the registered manager said any admissions would be staggered, to ensure staff were competent in meeting their needs. A robust staff recruitment system was in place.

People’s medicines were administered in a safe manner. Staff’s competency to administer medicines had been assessed and some shortfalls were found. Training was to be undertaken and competency reassessed, before staff were permitted to administer further medicines. Until this time, the registered manager was administering all medicines whilst on duty. We raised concern about the sustainability of this and what would happen if the registered manager was not available for a period of time. The registered manager did not see this as a problem.

Improvements had been made to the nutritional content of the meals with greater emphasis on fresh produce, baking and cooking “from scratch”. People told us they liked the food and had enough to eat and drink.

People told us they liked the staff and responded well to them. Staff felt supported in their role. A new system of formal staff supervision had been implemented and was working well. This gave staff the opportunity to talk about their role, their training needs and any challenges they were facing. A range of training courses had been arranged to help staff undertake their work more effectively. Training included topics associated with older age as well as mandatory subjects such as safeguarding and infection control. Staff were aware of their responsibilities of reporting a suspicion or allegation of abuse.

The registered manager had implemented the organisation’s quality monitoring processes. This consisted of various audits and encouraging people to give their views about the service they received. They could do this informally on a day to day basis, within newly introduced meetings or more formally with the use of surveys. People were clear that they would raise any concerns they had with the staff on duty or the manager. They said the good things about the home were the staff and the food. Improvements to the service had been recognised. However, suggestions for further improvement included improved décor and furnishings, en-suite facilities and outdoor space.

You can see what action we told the provider to take at the back of the full version of the report.