This inspection was unannounced and took place over three days on 5, 6 and 9 March 2015.
Mayflower Care Home provides accommodation, nursing and personal care for up to 76 older people. There were 65 people living at the service at the time of our inspection. Some people are unable to move independently, whilst others need support due to illness or other age related conditions. Some people are able to express themselves verbally, whilst others use body language and other types of communication. The service is divided into five units and each one aims to meet people’s specific needs. For example, one unit provides care and treatment for people who needed nursing care and people nearing the end of their lives. Another is designed to support people with complex needs, such as people living with dementia with mental health problems and behaviours that challenge.
The property is purpose built with flat access and adaptations suitable for people with restricted mobility. Each person has their own bedroom with en-suite facilities. Accommodation for people is over three floors accessed by passenger lifts.
When we last inspected the service on 5 February 2014, we found that the service was not meeting the Health and Social Care Act (Regulated Activities) Regulations 2010. People’s consent and their lack of capacity to consent to care and treatment was not recorded. Care plans did not contain guidance for staff about how people preferred to receive their care. At this inspection we found that breaches from the last inspection had been addressed.
There was a registered manager in post. 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.
At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.
People’s welfare was not always safeguarded by sufficient numbers of suitably qualified, skilled and experienced staff. The number of staff on duty and/or their deployment within the service did not always meet all the needs of all people in a timely manner. The shortfall in permanent staff affected the delivery of care for some people.
People were not always protected against the risks associated with the unsafe use and management of medicines. Safe medicine administration procedures were not always followed and could put people at risk.
The areas which accommodated people living with dementia contained some notices to help orientate people. However, the environment was not specifically designed to aid orientation for people living with dementia. We have made a recommendation about this.
There were activities organised in which people could participate. However, these were not always sufficient or specific enough to meet people’s differing needs or preferences and prevent social isolation. We have made a recommendation about this.
Staff knew the correct procedures to follow. However, policies and procedures did not provide staff with written up to date best practice guidelines, including any changes in legislation. We have made a recommendation about this.
The registered manager had a good understanding of how to work with, and follow advice from the local safeguarding authority to protect people. Staff identified and managed risks to people’s safety. People lived in a clean environment. Staff had a good understanding of infection control practice and took measures to ensure that the service was clean and free from the risk of infection. The provider ensured that the premises were maintained safely and securely.
The service operated safe recruitment procedures which made sure staff employed were suitable to work with people. Staff had the appropriate skills and experience to meet people’s needs. They were able to put this into practice by using the knowledge they had gained from training. Staff were supported to work to expected standards through supervision.
Staff sought people’s consent before they carried out any care tasks. Where people lacked the mental capacity to make decisions the service was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests. The system for monitoring Deprivation of Liberty Safeguards (DoLS) within the service protected people from harm and protected their rights.
People were supported to have a choice of food and drink and could choose where they had their meals. Staff took action to reduce the risk to people from poor nutrition and dehydration. People were supported to manage their health care needs and had access to health care professionals, such as a G.P. They were referred to specialists or for hospital treatment where necessary.
People told us they liked their bedrooms and the environment in which they lived. There were various communal areas where people could spend their time.
Staff treated people with kindness. People were supported with their preferences and involved in their care planning in their day-to-day lives. Staff demonstrated respect for people’s dignity and were careful to protect people’s privacy. Staff promoted people’s independence. Specialist care was provided for people who were nearing the end of their lives.
People who were considering moving into the service were assessed to determine if the service could meet their needs. People’s care was personal to the individual and care plans provided guidance for staff about people’s preferences and how they wanted their care to be delivered.
Staff communicated effectively with people, responded to their requests and offered people choices.
The provider had a clear set of vision and values. The service had a clear, accountable management and staffing structure. The service had a welcoming, pleasant and busy atmosphere. People, staff and their relatives thought the registered manager was approachable.
People, their relatives, members of staff and professionals associated with people’s care were asked for their views about how the service was run. These were acted on to improve the service provided. The manager investigated and responded to people’s complaints and concerns. There were regular audits to review the quality of care and safety of the premises.