Archived: Mayflower Court Residential Home

We found the following examples of good practice.

A ‘booking in’ procedure was in place for visitors to the home including, evidence of a negative lateral flow test, COVID-19 vaccination, temperature taken and a health questionnaire. This helped prevent visitors spreading infection on entering the premises.

The home facilitated face to face visits, in line with government guidance. Any changes to government guidance was implemented immediately. Visitors were kept up to date with any changes through telephone, email and written communication.

Visits were conducted in people's own rooms to minimise any traffic within the home. The home planned to install a marque in the spring to enable visitors the choice of visits in the open air. Alternatives to in-person visitation, such as virtual visits, were supported, as and when necessary.

The home also offered 'step down beds' for people requiring a short period of respite following a stay at hospital. People were admitted safely and in line with the most up to date government guidance.

People and staff were tested regularly for COVID-19. Staff employed at the home had been vaccinated, to help keep people safe from the risk of infection. Some staff had received their COVID-19 booster vaccinations.

Individualised risk assessments for both people and staff were used to help minimise risk of infection transmission. Assessments were also used for people and staff who were deemed to be more clinically vulnerable to the risks of COVID-19.

The home was clean, hygienic and homely. Paintwork in some communal areas was chipped which could impede effective cleaning, but the home had plans in place for a refurbishment, and planned to increase more domestic staff to help implement good infection control practices.

Laundry facilities were located in an outbuilding separate to the home, which helped minimise risk of infection from contaminated laundry.

Infection control policies and procedures helped ensure that the home adopted best practice which complied with current guidance. Cleaning schedules and audits were in place to help maintain cleanliness and minimise the spread of infection.

Staff were trained in how to put on and take off PPE. Posters located near PPE stations acted as a visual reminder to staff on good practices and the home had adequate supplies of appropriate PPE. Staff had also received training in effective infection prevention and control practices.

The manager maintained links with external health professionals to enable people to receive the care and intervention they needed.

We found the following examples of good practice.

• The service had procedures and protocols in place which ensured people were admitted into the service and people could visit the service safely in accordance with national guidance.

• People and their relatives were supported to understand the isolation procedures and infection prevention and control measures. The service helped to alleviate people feeling lonely, by providing access to safe supervised visiting, in accordance with national guidance, and video and telephone calls with friends and loved ones.

• Staff were supported in isolation/sickness absence by the provider. Staff support and wellbeing was considered and enhanced during the pandemic.

• Personal protective equipment (PPE) was widely available and used correctly and there was an extensive testing program in place for staff, people using the service and visitors.

• The home was clean and hygienic throughout. Areas in the home had been redesigned to enable effective social distancing.

• Staff were trained in infection prevention and control (IPC), had completed frequent refresher training and had access to the latest guidance on COVID-19. There were good links with the local community IPC team for guidance and support.

• There was an IPC policy and procedures in place. Contingency plans were in place for future service disruption, including due to infection outbreaks and winter pressures.

Mayflower Court Residential Care Home is situated in the residential area of Oxton, Wirral. The home is registered to provide accommodation and support for up to 20 older people. At the time of our inspection, there were 17 people living in the home.

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

At the last inspection systems in place to monitor the quality and safety of the service were not effective. During this inspection we found that improvements had been made and the provider was no longer in breach of regulation, although some areas for improvement were identified. Feedback regarding the management and quality of service people received was positive and staff told us they were well supported and could raise any issues they had with the registered manager. The ratings from the previous inspection were displayed as required.

At the last inspection we found there was not always enough staff to meet people’s needs in a timely way. Improvements had been made and people received support in a timely way. Records regarding safe recruitment were not always clearly maintained. We made a recommendation regarding recruitment practices. Regular checks were made on the building and utilities to ensure they remained safe. However, not all required equipment checks were recoded clearly. People told us they felt safe living in the home and were supported by staff who knew safeguarding procedures and how to raise any concerns they had. People had their medicines administered by staff who had undergone training and had been assessed as competent. The home appeared clean and well maintained.

Staff were knowledgeable regarding people’s needs and preferences; however, some care plans required updating to ensure accurate and detailed information was recorded. People’s communication needs had been assessed and records were provided in different formats when required. There was a range of activities available and people’s friends and families were able to visit at any time and were made welcome by staff. A complaints policy was available, and people knew how to raise any concerns they had.

People told us they got on well with staff and were treated with dignity, kindness and compassion and encouraged to be as independent as possible. We observed positive, familiar interactions between people living in the home and staff. People were provided with information about the service and supported to make decisions regarding their care. Their feedback regarding the service was sought regularly through meetings and satisfaction surveys.

Systems were in place to gain consent and record people’s consent. 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. Pre-admission assessments were completed before people moved into the home to ensure staff could meet their needs. Staff were supported in their roles through ongoing supervision and regular training. Feedback regarding meals available was positive and people had enough to eat and drink.

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 8 February 2019). We identified breaches of regulation regarding staffing, consent and the governance of the service at that inspection. During this inspection, we found that improvements had been made and the provider was no longer in breach of regulation.

Why we inspected

This was a planned inspection based on the previous rating.

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.

People’s experience of using this service: There were not always sufficient numbers of staff on duty to meet people’s individualised needs in a timely way.

Systems in place to monitor the quality and safety of the service did not identify the issues we highlighted during the inspection. The provider had not displayed the last rating of the service on their website as required.

Risk to people had been assessed but records were not always up to date. We made a recommendation about this in the main body of the report.

Plans of care reflected people’s preferences and had been reviewed regularly, however they did not always reflect people’s current needs. The registered manager was in the process of reviewing and updating all care files.

Consent was not always sought and recorded in line with the principles of the Mental Capacity Act 2005. Applications to deprive people of their liberty had been made appropriately, but records did not clearly reflect those that had been authorised. Following the inspection, the registered manager told us consent had now been sought and recorded.

People’s nutritional needs were known and met by staff, however the feedback we received regarding the meals available was mixed. Systems were in place to gather feedback from people regarding the service.

Activities were available to people within the home, however there were no activities available within the community, which people told us they would like.

Staff had been recruited safely to ensure they were suitable to work with vulnerable people. They were supported in their role and received regular training to help ensure they had the knowledge and skills to support people safely.

People living in the home told us they felt safe and their relatives were confident that safe care was provided. People told us they received their medicines when they needed them and we found that they were managed safely. The building and equipment were maintained to ensure they remained safe. Relevant equipment was available to enable staff to meet people’s needs.

People told us staff were kind and caring, protected their dignity and treated them with respect. Staff knew the people they were supporting well and spoke about people warmly. Staff supported people to be as independent as they could be.

People and their relatives knew the registered manager and felt able to speak to them if they had any concerns.

Rating at last inspection: Rated good at the last inspection in May 2016 (Report published August 2016).

Why we inspected: This was a planned comprehensive inspection based on the previous rating.

Enforcement: You can see what action we told the provider to take at the end of the full version of this report.

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

There was a registered manager working at 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.

The manager had a warm and kind approach to people. Staff and visitors we spoke with told us they found her approachable. She consulted with people and was open to new ideas. Staff members told us they felt well supported by her. The manager was visible and there was a culture of continuous improvement at the home. She completed regular audits of the home and its processes. People’s relatives that we spoke with told us that communication from the manager and staff at the home was good and timely.

Many people we spoke with commented positively on the atmosphere and feel of the home. We observed staff to be warm and kind towards people, using people’s names, treating people with dignity and respecting their private space. During less busy times of the day staff told us they liked to sit and chat with people and their visitors. Visitors came and went from the home throughout the day, those we spoke with told us they were made to feel welcome at the home. The home had recently recruited a new activities co-ordinator and there was a range of activities available to people.

There was an adequate number of staff to meet people’s needs. People living at the home and their relatives told us they felt the home was a safe place. The environment people lived in and the care people received was safe. The home was clean, well maintained and clutter free. The manager had arranged for a series of health and safety checks and services to be completed on the homes safety systems, equipment used by people and the maintenance of the home’s environment. Accidents and incidents were recorded and learnt from. People’s medication was stored and administered safely.

Staff received training on safeguarding vulnerable adults and understood how to keep people safe from harm. New staff went through a number of checks to ensure they were recruited safely. New staff also received initial induction training and at first shadowed an experienced member of staff.

People were treated as individuals and were supported to make decisions regarding their care. People’s care records we looked at were recent, person centred and they had regular dated reviews. They contained brief information about the person, their care plan and risk assessments. Daily care notes were updated on a computer system that was password protected. Information relating to people’s health had been used effectively when supporting people to access healthcare services. Health and social care professionals who visited told us that they had confidence in the care at the home and the staff, “advocated for people”.

Staff received training and periodic refreshers that were appropriate to their role. In addition to this they received regular supervision meetings and annual appraisals with the manager. Staff were also invited to staff meetings and could place items for discussion on the agenda. Staff we spoke with told us they felt comfortable approaching the manager when necessary. Staff told us they felt well supported in their role.

People told us they enjoyed the food provided. It was cooked fresh and there was a variety of options available to people. The cook catered for people’s different tastes and dietary requirements. The kitchen had been awarded the highest rating of five stars by environmental health.

The support and care offered to people was done so in a respectful way. People were supported to make decisions as much as possible for themselves. People living at the home were consulted with on matters relating to their care and the home environment. The care at the home was in line with the principles of the Mental Health Act (2005). Some people had a Deprivation of Liberty Safeguard (DoLS) in place, for some other people the manager had submitted an application to the local authority.

The home and its grounds were well maintained. People showed us their rooms and told us they had been supported to personalise them, there had been recent improvements to the décor of some people’s rooms.

People said it was, 'marvellous here; the staff are wonderful', and that they were 'very impressed with the care' that people received. A relative said that they had been 'involved from the start' and that staff were all approachable and friendly. We saw detailed accounts of people's preferences and needs in their care plans.

Staff who administered medicines had received training and told us about the procedures that they followed to ensure the safety of people using the service. These matched the policy documents that we saw.

The people that we spoke to said that they had never had reason to make a formal complaint. They said that any small concerns that they had raised with staff had always been acted upon.

We saw staff interacting and caring for people who used the service in a kind and friendly way. Staff were able to describe the needs of different service users showing us that they understood what care individuals needed.

Staff told us that they had received training about all aspects of care relevant to the service when they started work at the home and that they received regular update training. We saw records that confirmed this. Staff said they felt supported by their colleagues and their manager.

At this visit we found that improvements had been made to records. We found that care files had been reviewed and risk assessments had been put in place in relation to mobility and falls. We saw records that people had been referred to the falls team and requests had been made to supply assistive technology. In the absence of the assessments being undertaken we found that action had been taken when possible to minimise the assessed risks.

We found that records had been improved and identified signs and symptoms of the individual's care needs relating to their mental health.

Visitors to the home told us they had no concerns regarding the care of the people in the home.

We observed care workers and the manager engaging with people in a sensitive and caring manner. People who used the service told us they were happy the service provided and felt valued and cared for.

The six care records looked at had information about people's personal histories, interests and lifestyle choices. This meant the service supported and promoted people's diversity, values and respected people's human rights. However there was limited information in their mobility care plans or falls risk assessments.

The three relatives spoken with told us they felt their relatives were safe living at Mayflower Court and that a good standard of care was provided. They told us if they had any concerns they would feel comfortable discussing them with the manager or the register provider.

There were systems in place to monitor the quality and safety of the service provided. The nominated individual for the company carried out a monthly audit of the service.