Mayfield Road

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed all the quality statements within this key question. Our rating for this question has improved to Good. Improvements had been made to ensure the service was staffed appropriately, and that all staff were appropriately trained and supported in their role. Improvements had also been made regarding the management of possible risks to people’s safety and people now received safe care and support. Staff followed the provider’s policies and procedures regarding infection prevention and control, medicines management, safeguarding adults and the management of incidents to ensure people remained safe.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s family members told us that the provider had taken actions to address issues identified at the last CQC inspection. Comments included, “I spoke to one of your colleagues at the last inspection, it’s significantly improved since then”, “There’s an up and down history with Mayfield. I have to say it’s improved”, “It is getting better, you can feel it when you go in there” and “The biggest improvement is leadership and input.”

The provider had an action plan in place aimed at reviewing processes and any learning shared. The registered manager told us they worked actively towards improving the areas of concern identified during the last CQC inspection and also as recommended by the local authority. This was in relation to people’s care plans, activities and building trust with the families. The provider had timelines for actions to be completed but also acknowledged that in some areas the work was on-going such as making cultural changes at the service.

Processes were in place to record and review any incidents that occurred. So they could be learnt from and where required, additional measures could be implemented to reduce the risk of recurrence.

People had their care and support needs assessed before they started using the service. A family member told us, “[The registered manager] checks all the family history.” People’s views and choices were gathered and people were included in their care planning where they were able to and wanted to participate.

The registered manager told us about the systems they had in place to ensure continuity of care at the service. This included staff having access to people’s care plans and families being involved in care planning because they knew people best. Shadowing of more experienced staff members was used to help the new employees to get to know people before they started supporting them.

Partner agencies told us there were good systems in place to ensure safe transitions between services and ensure continuity of care.

There were safe systems in place to ensure clear transitions when people moved between services. This included obtaining information about people’s needs and clear communication.

People were safely looked after at the home. Family members told us, “[My relative] is safe there. She has 1 to 1. There’s always someone with her”, “I do feel [my relative] is safe there”, “It’s safe now but not in the past no” and “You’re inclined as a parent to look around a bit more, but I’ve never found anything untoward.”

Staff were aware of the safeguarding procedure and knew how and when to raise a safeguarding concern. A staff member told us, “[Safeguarding] is about taking care of the residents and protecting them from abuse. Any concerns, I would report to the front-line manager.” The registered manager said that any allegations of abuse were taken seriously and investigated as necessary making sure people were safeguarded from the risk of abuse.

People were able to express their views and choices without fear. We observed that people came close to staff when they wished to, felt comfortable around staff and facilitated a physical contact. People asked staff for support and assistance when they needed it, for example to make a cup of tea.

Safeguarding adults’ policies and procedures were in place. Staff followed processes to ensure any safeguarding concerns were reported and recorded. There were systems in place for the management team to review safeguarding adults’ concerns to ensure they were learnt from.

The environment was well equipped and supported people’s individual needs. Family members told us, “[My relative] has a hoist and [staff] seem to know how to use it” and “[My relative] has the wheelchair for outside.” People were supported by staff to move around the home and use the necessary equipment such as hoists and wheelchairs safely and comfortably.

Staff knew people’s preferences and understood triggers that caused them stress. Staff were aware of the methods they had to use to support people’s good behaviours and where necessary to de-escalate situations that put people at risk. Staff followed people’s seizure protocols and knew the actions they had to take to help people manage their epilepsy.

People were empowered to take risks. This included a person taking a health-related risk which they had capacity to consent to. Risks were explained to the person and a risk management plan was agreed making sure staff supported the person in the way that they wanted them to. We saw staff approaching people for support when needed and intervening in a timely way, for example when they saw a person requiring help with mobilising.

There were processes in place to identify risks to people’s safety. People’s care records contained management records to inform staff about how to support people to manage any risks to their safety. Improvements had been made and detailed seizure charts were now being maintained.

People received support to personalise their rooms and were included in decisions relating to the interior decoration. Family members told us, “[My relative’s] room is nicely decorated. It’s homely and personalised. [My relative] has got whatever she wants in her room” and “[My relative] has a nice room there.” People’s bedrooms reflected their tastes and hobbies, including favourite colours and activities they liked to take part in.

The provider undertook quality audits to inform improvements to the environment. The management team told us that regular audits were completed to check the equipment being used by people making sure it was working properly. Staff said that repairs had been carried out promptly since the new registered manager had started working for the provider.

The home was spacious and had plenty of natural light. We observed the communal areas being well furbished and there were no trip hazards. Different seating areas provided options for people to spend time on their own and to socialise when they wanted to. People had access to the garden where they spent time relaxing. The registered manager told us they were in the process of ordering decorations and wall art for those areas at the home that were less personalised and felt homely.

Systems and processes in place ensured that people lived safely at the home. Fire safety tests were completed, and any learning points identified were addressed by the management team as necessary. Risks related to the use of stairs were assessed to avoid risk of injury.

The numbers and skills of staff matched the needs of people using the service. Comments made by the family members included, “Most of the time there’s enough staff, and they seem well trained as well”, “The quality of staff is much better. Before the staff had a lack of awareness” and “There’s enough staff now I believe. They’ve employed new ones so there’s big improvement.”

The service had enough staff. The registered manager told us that changes made to improve the service’s culture resulted in a number of staff leaving. During the recruitment of new staff, the management team ensured they had the necessary values aimed at providing good quality care for people. The service was fully staffed now. Additional staff were provided to support people with trips and hospital appointments when needed.

Staff were available at all times when people needed their assistance. We observed staff being knowledgeable about people's care and support needs, including knowing how to manage their anxieties and planning of the day.

Safe recruitment processes were in place to ensure suitable staff were employed at the service. Staff now received regular training and supervision to ensure they had the knowledge and skills to undertake their duties. Dependency tools were used to calculate safe staffing levels and ensure there were enough on duty to meet people’s needs. Rotas confirmed the service was now staffed in line with those tools.

The service had good arrangements in place for keeping the premises clean and hygienic. A person told us they received the necessary support to keep their room tidy and in the way they liked it. Comments made by the people’s family members included, “The home is clean now, it wasn’t before. It’s very much improved” and “It’s always clean and tidy, they have a permanent cleaner, and the bed linens all done.”

Staff used personal protective equipment (PPE) effectively and safely. Their comments included, “We have gloves and aprons. I use PPE when doing personal care or meds” and “When we do personal care, we wear PPE. We use the black bin or end bin as needed to get rid of it. We also wash our hands after.”

The service prevented visitors from catching and spreading infections. Hand sanitisers and soap were available to use for staff and visitors. To keep people safe when people were not feeling well, the service followed social distancing rules and used PPE effectively.  However, during our visit we noticed that timely action was not always taken to prevent infection outbreaks. This was in relation to maintenance and storage of cleaning and leisure equipment. When noted, the staff team took immediate actions to address these areas of concern.

There were regular infection prevention and control (IPC) audits in place to ensure staff were adhering to good practice and in line with the provider’s IPC policy.

Staff provided the support people needed to take their medicines safely. Family members told us, “There are no issues with meds and there never has been” and “As far as we are aware [staff] give [my relative] his meds on time.”

Staff followed effective processes to check that people had the correct medicines. A staff member told us, “We need to talk to the service users and tell them everything we do. We use Medicine Administration Record (MAR) charts, and it tells you the time, date and what to do making sure all is correct. We have to sign after giving the meds. If a service user is refusing, I call someone to help me. We would also try with the managers again. If the meds are still refused, we call 111 for support. This does not happen often.” Staff told us that people’s records had guided them regarding the support people required to take their medicines safely.

People were supported by staff who followed systems and processes to prescribe, administer, record and store medicines safely. MAR charts were properly completed and signed. Any information required in relation to 'as required' medicines was available and guided staff when these medicines should be given to people, for example if a person was in pain. People’s medicines were stored safely and only authorised staff had access to the medicines.