Mayfield Road

Mayfield Road is a residential care home providing personal care to up to 12 people. The service provides support to people with a learning disability and/or autistic people. The service also specialised in supporting people with epilepsy. At the time of our inspection there were 12 people using the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

People did not have a fulfilling and meaningful everyday life. People were not supported to develop skills, including independent living skills. Whilst some people were supported to attend activities that supported their physical health, for example, hydrotherapy, there was not a programme of individually tailored activities for people. This was something the management team were aware of and had plans to develop.

The service did not give people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. People did not benefit from an interactive and stimulating environment. A refurbishment and redecoration programme had recently begun throughout the service. A new kitchen was being installed and some bedroom furniture had been replaced.

Staff enabled people to access specialist health care support in the community. Staff supported people with their medicines.

Right Care:

People did not always receive kind and compassionate care, and people were not always treated well and with dignity. People’s care and support plans reflected their range of physical health needs, but did not address their wants, interests or preferences in order to promote their wellbeing and enjoyment of life. People were not consistently supported to stay safe, due to concerns raised about the recording of epilepsy care and environmental safety concerns. Nevertheless, staff were aware of how to support people in the event of a seizure.

There were times when the service was short of staff. Staff did not always have the skills and knowledge to meet people’s needs, as they had not completed all their mandatory training. Additional training was scheduled to be carried out.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture:

People and those important to them were not always involved in planning their care. Staff did not always evaluate and review the quality of support provided at regular intervals or in line with changes in people’s needs. Relatives did not feel their views were always listened to and acted upon. However, the provider’s quality team had started to take action to rebuild this relationship. The management team were also aware that people’s care needed reviewing and they were organising with people’s funding authorities for care reviews to take place.

Governance processes were not always adhered to and were not sufficiently completed at times to identify and address concerns in a timely manner. The provider was starting to take action to improve the quality of the service. The provider’s quality team and senior management team had been in to review the service. A comprehensive service improvement plan was in place. The interim manager had begun to make improvements. The provider was in the process of recruiting a permanent dedicated manager for this service.

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 13 December 2017). We undertook a targeted inspection in January 2022 looking at infection prevention and control procedures.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement

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

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, which will help inform when we next inspect.

We found the following examples of good practice:

The provider was following best practice guidance to prevent visitors to the home spreading COVID-19 infection. The provider kept in touch with family members and people's friends through emails and phone calls. The provider had a detailed management of visitors’ policy in place.

The provider had arrangements for visitors to meet with people virtually through video conferencing and physically in the service including window visits. All visitors were asked to complete a COVID-19 screening form on arrival, and had their temperature checked. Visitors had to show proof of their COVID-19 vaccination and proof of negative lateral flow test taken on the day of the visit. People were supported to see their family in the garden during summer. The provider informed us that all visitors had to wear masks inside the care home.

All COVID-19 positive service users were isolated according to Public Health England Guidelines and parents who take their children were appropriately tested on return.

The provider informed us that all service users required personal care and staff used Personal Protective Equipment including gloves, mask and apron when providing personal care and when social distancing was not possible.

The provider had an admissions process in place. Service users had to have had undertaken a COVID-19 PCR test within 24 to 48 hours prior to being admitted into the service and on entry a lateral flow test and PCR test was taken. The service users were kept in isolation until they get a negative COVID-19 PCR test result.

The home had PPE stations for staff to don and doff (put on and take off) Personal Protective Equipment (PPE).

Our observations during the inspection confirmed staff were adhering to PPE and social distancing guidance.

The provider informed us that all staff undertook daily COVID-19 lateral flow tests and a weekly PCR tests. The provider confirmed to us that all staff working at the service had received the first two doses of COVID-19 vaccine and staff were in the process of receiving their booster dose. The provider had maintained a vaccination register for staff and service users.

The provider informed us that all staff had received the infection prevention and control and personal protective equipment training.

The provider had ensured staff who were more vulnerable to COVID-19 had been assessed and plans were in place to minimise the risk to their health and wellbeing. The provider informed us that they had an open-door policy and supported the wellbeing of staff through informal discussions; the provider informed us that they ran a voucher scheme for staff and provided staff with Christmas gift bags.

Further information is in the detailed findings below.

Mayfield Road accommodates twelve people with a learning disability in one adapted building. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion.

This inspection took place on 13 December 2017 and was unannounced. At our last comprehensive inspection of the service in October 2016 we gave the service an overall rating of requires improvement. We found the provider had not sufficiently addressed issues we had identified at a previous comprehensive inspection of the service in January 2016 and were in breach of the regulations because medicines were not managed safely and there was a risk that people did not receive 'as required' or covertly administered medicines safely. Some medicines were not stored at appropriate temperatures and medicines were not disposed of appropriately. We found the provider’s quality improvement systems were not always effective as the issues we identified at our previous inspection had not been improved. We also found care plan reviews were not always effective in making sure care records were kept up to date.

At this inspection we found the provider had taken action to make improvements and now met legal requirements. Information was available to staff to help them support people with their ‘as required’ medicines so that they received pain reliving medicines promptly and appropriately. Staff had access to the provider’s policies for homely remedies and covert medicines. This helped to ensure people received safe and appropriate support with their medicines in these specific situations, which adhered to their legal rights. People received the medicines prescribed to them. Stocks were regularly checked and accounted for and systems were in place to dispose of medicines safely. Medicines were stored safely and securely. The temperature of the room and fridge where medicines were stored was taken daily and was within safe recommended ranges so that people’s medicines would continue to remain effective and safe to use.

The provider’s audit systems were now used effectively to make improvements to the quality of care and support provided to people evidenced by the improvements made and sustained since our last inspection to medicines management arrangements. Senior staff undertook regular monitoring and audits of other key aspects of the service. When gaps or shortfalls in the service were identified required improvements were made promptly. People’s care records and associated documents were reviewed monthly to check these were complete, accurate and up to date.

Since our last inspection a new registered manager had been appointed at the service. 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was aware of their registration responsibilities and submitted statutory notifications about key events that occurred at the service as required. People and staff spoke positively about the management and leadership of the service. The registered manager promoted an inclusive and open culture in which people and staff were encouraged to share their views and participate in developing the service. The provider maintained arrangements to deal with people's complaints appropriately if these should arise.

People were safe at Mayfield Road. Staff knew how to protect people from the risk of abuse or harm and followed the provider’s safeguarding policy and procedure for reporting concerns promptly. Risks to people's health, safety and wellbeing were assessed and reviewed and staff followed appropriate guidance to minimise these risks. Senior staff reviewed all incidents to identify triggers and specific patterns of behaviour that may have contributed to these. The provider continued to maintain a servicing programme of the premises and the equipment used by staff to ensure those areas of the service covered by these checks did not pose unnecessary risks to people. Staff followed good practice to ensure risks to people from poor hygiene and cleanliness were minimised.

There were enough staff to keep people safe. The provider maintained robust recruitment checks to assure themselves of staff's suitability and fitness to support people. Staff received regular and relevant training to help keep their knowledge and skills up to date with best practice. Staff felt well supported by senior staff and the provider. Staff knew people well and had a good understanding of their needs, preferences and wishes. They were aware of people’s communication methods and how they expressed themselves.

People continued to receive support that was personalised and which met their specific needs. Staff used information and guidance, based on best available evidence and best practice, to plan and deliver care that would support people to experience good outcomes in relation to their healthcare needs. Senior staff reviewed people's needs regularly to ensure the support they received continued to meet these.

People were supported to eat and drink enough to meet their needs. People were also supported to access healthcare services when needed and staff liaised with health and social care professionals to ensure people received effective coordinated care in regards to any health needs. Staff encouraged people to participate in activities and events and to maintain relationships with the people that mattered to them. Staff were welcoming to visitors to the home and friends and families were free to visit when they wished.

Staff were kind, attentive and treated people with dignity and respect. They ensured people's privacy was maintained particularly when being supported with their personal care needs. People were encouraged to do as much as they could and wanted to do for themselves to retain their independence. People were asked for their consent before care was provided and prompted to make choices. Staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and supported people in the least restrictive way possible. The policies and systems in the service supported this practice.

The provider supported the service to continuously improve and worked in partnership with others to develop and improve the delivery of care to people. Since our last inspection the service had been accredited as an approved service provider by a national charity for supporting people with a brain injury. The provider was also assisting in trials of new technology to improve outcomes for people living with epilepsy. Senior staff attended multi-agency meetings with the local authority, the police and other healthcare professionals to develop joined up, coordinated responses when dealing with concerns about people. The service was also participating in a pilot initiative aimed at improving end of life care for people with a learning disability. This would ensure that people would be afforded the comfort and dignity they deserved at the end of their lives.

Mayfield Road provides personal care to up to 12 adults with epilepsy and a range of other needs, including those arising from acquired brain injuries, physical disabilities and learning disabilities. At the time of our inspection there were 10 people using 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.

At our last inspection in January 2016 we found the provider was in breach of the regulation about safe care and treatment because medicines were not managed safely. We rated the service ‘good’ but the key question, “Is the service safe?” was rated ‘requires improvement.’ At this inspection, we found the issues were not sufficiently addressed and the provider was still breaching the regulation about safe care and treatment. There were no protocols in place for administering ‘as required’ pain medicines or homely remedies, which meant we could not be sure people were able to receive these safely. Homely remedies are medicines that people can buy without a prescription. The policy to follow when giving people medicines covertly (without their knowledge) was not easily accessible to staff, which meant people were at risk of receiving medicines in an unsafe way or without their consent. There were no systems in place to ensure all medicines held at the service were accounted for or to ensure that excess medicines were disposed of. This meant medicines could be misused or lost without the provider knowing. Medicines were not always stored at appropriate temperatures, which could make them unsafe or ineffective.

We also found the provider was in breach of the regulation about good governance, because their audits and quality improvement processes were not effective in making the required improvements in their management of medicines. We also found out of date information in a care plan even though it had been reviewed recently.

We will add full information about CQC’s regulatory response to any concerns found during inspections at the back of this report after any representations and appeals have been concluded.

People were protected from harm and abuse, because staff knew how to report any concerns they had and there were systems to ensure staff did not use inappropriate restraint. Risk management plans were in place to keep people safe while restricting their freedom as little as possible. There were checks and management plans in place to ensure there was a safe environment for people to live in and the provider had systems to monitor accidents and incidents to identify any trends and address them.

There were enough staff to care for people safely, although the service was experiencing some problems with staff absenteeism. However, at the time of the inspection this problem was being addressed by the provider. They also vetted new staff to ensure they were suitable to work at the service. Staff received an induction, training, supervision and support from relevant professionals to equip them with the knowledge and skills they needed to work effectively, including specialist knowledge and advice on best practice.

The provider was meeting the requirements of the Mental Capacity Act (2005). This helped to ensure the correct legal procedures were followed when decisions needed to be made on behalf of people who did not have the mental capacity to do so for themselves. Where people needed to be deprived of their liberty to receive care, this was done within the appropriate legal framework to ensure people’s rights were upheld. Where people did have capacity, staff gained their consent before carrying out care tasks.

People were able to choose from a variety of healthy food that met their nutritional needs. They received the support they needed to access healthcare services.

Staff were caring in their interactions with people. They knew people well, communicated with them in ways that were suitable for their individual needs and understood when people needed space or quiet time. Staff enabled people to make choices about their care and how they lived their lives. They worked in a way that promoted people’s dignity and independence.

Care was planned to meet people’s physical, emotional and social care needs. Care plans were comprehensive and described in detail how staff should support people with care tasks. Although people’s likes and dislikes were not always included in descriptions of how to care for them, there were lists of likes and dislikes that staff could refer to. Logs showed that people received their care as planned. The service had a diverse range of planned activities to meet people’s needs.

There were systems in place for the provider to deal with complaints and concerns, including accessible information and forms to support people in making complaints.

People said they liked the home manager and staff were able to access the support they needed, including out of hours. There was a fair and open culture, which enabled people and staff to speak up about any concerns they had, and the staff team was supportive. Managers and senior staff communicated effectively with the staff team about any changes in the way they needed to work.

The provider carried out regular checks of the environment and the quality of interactions between staff and people. They involved people and their relatives in the quality improvement processes and this contributed to an empowering culture where people’s voices could be heard.

Mayfield Road provides accommodation, care and support for up to 12 people with epilepsy, some of whom also have learning disabilities and/or physical disabilities. Since Mayfield Road opened in August 2015 the home had been gradually moving people in to live there. At the time of our inspection seven people were using the service.

There was a registered manager in post who was one of the provider’s operations managers. The service manager who was in charge of the day to day management of the service was in the process of applying to become the registered manager. 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.

Safe medicines management processes were not consistently followed. Whilst people had received their medicines as prescribed we identified that there were some stock and recording errors. This was a breach of a legal requirement and you can see what action we have asked the provider to take at the back of the main body of the report.

People received care and support that was personalised and their individual support needs were met. Staff were aware of what level of support people required and supported them in line with their preferences. Staff were aware of the risks to people’s safety and worked with them to manage and minimise these risks.

The provider’s medical team reviewed people’s health needs, particularly in regards to their epilepsy and seizure activity. Staff liaised with other healthcare professionals to ensure people’s health needs were met. Staff were aware of people’s dietary requirements and provided support in line with advice and guidance provided by healthcare specialists.

Staff were aware of people’s communication methods and involved them in decisions about their care. People were offered choice and support in line with their decisions and preferences.

Staff encouraged and supported people to identify what activities they enjoyed, and supported them to access activities at the service and in the community. The staff were in the process of further developing the activities on offer and working with people to develop individually tailored activity plans.

A new staff team were in place. Staff were aware of their roles and responsibilities, and were being supported to identify their strengths and embed these at the service. Staff received an in-depth training programme to ensure they had the knowledge and skills to support people. Staff were supported by their manager and received regular supervision.

Staff were knowledgeable about the procedures to follow in the event of an incident and if they felt a person was at risk of harm. The management team reviewed all incidents and liaised with the local authority safeguarding team if they needed any additional advice to protect people from harm.

Systems and processes were in place to review the quality of the service. This included formal monthly checks, management spot checks and reviews by relatives of people who used the provider’s other services. Any areas identified as requiring improvement were addressed and the necessary action was taken to improve service delivery.

The service manager was dedicated to improve the quality of the service and the support provided to people. They were liaising with the local authority to participate in good practice initiatives and were developing systems to obtain further feedback from people about the service.