Archived: Mayfield House Care Home

We found at this inspection that the provider had sustained and embedded the necessary changes to their recruitment process and there was no longer a breach of regulation.

Mayfield House Care Home is a care home for people who require personal care. People in care homes receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Mayfield House Care Home is registered to provide accommodation and support for up to 12 people who may be living with a learning disability. At the time of the inspection there were four people living there.

The service had a 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. The registered manager was also the provider.

People were cared for by staff who had received appropriate training, support and supervision in their role, however due to staff challenges this year, there had been a delay in some staff training. We asked the provider to book the relevant training in as a matter of urgency; we received confirmation that this had been done.

People's care and support needs were assessed and care plans developed based on best practice guidance. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were supported to eat and drink sufficiently for their needs. People were supported to access healthcare services, such as GPs and specialist nurses and therapists in order to maintain good health and wellbeing.

The provider had systems in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely. Recruitment processes were in place to make sure people were supported by staff who were suitable to work in a care setting. There were arrangements in place to store medicines safely and administer them safely and in line with people's preferences. Arrangements to control and manage the risk of infection were established in line with national guidance.

People experienced good continuity and consistency of care from staff who were kind and compassionate. The registered manager had created an inclusive, family atmosphere at the home. People were relaxed and comfortable in the presence of staff who invested time to develop meaningful relationships with them. People's independence was promoted by staff who encouraged them to do as much for themselves as possible. Staff treated people with dignity and respect and were sensitive to their needs.

The service was responsive and involved people in developing their care plans which were detailed and personalised to ensure their individual preferences were known. People's care plans had information about their care needs, as well as their wishes regarding independence and any risks identified and how to minimise these. If a person's needs changed, their care plans were updated. Arrangements were in place to obtain the views of people and their relatives and a complaints procedure was available for people and their relatives to use if they had the need.

The registered manager provided support to staff. The safety and quality of the support people received were monitored and any identified shortfalls were acted upon to drive recognised improvement of the service. However due to a period of absence by the registered manager, systems had not ensured staff training was up to date, this did not impact on the quality of care provided for people.

This report only covers our findings in relation to the key question of safe. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Mayfield House Care Home’ on our website at www.cqc.org.uk.

Mayfield House Care Home is registered to provide accommodation and support to 12 people who have a learning disability. At the time of the inspection there were five people living there.

The service had a 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.

People told us they felt safe living at the service.

At our focused inspection of 13 June 2017, we found legal requirements in relation to the safe recruitment of staff had been met. People were safe as they were cared for by staff whose suitability for their role had been assessed. However, it will take further time for the registered manager to be able to demonstrate that these improvements have become embedded and sustained over time.

There were sufficient staff to meet people’s care needs. Arrangements were in place to ensure additional staff could be called upon to work if required for people.

The registered manager had arranged for new staff who had not yet attended safeguarding training to do so. Staff had access to both the provider’s and multi-agency safeguarding policies to provide them with written guidance about safeguarding people from the risk of abuse. Staff spoken with understood their role in protecting people from the risk of abuse. It will take further time for all staff to complete their safeguarding training.

Risks to people had been identified and written guidance was in place for staff regarding how these were to be managed to ensure people’s safety.

Processes were in place to ensure people’s medicines were managed safely by trained staff. Further time is required to ensure all relevant staff have undertaken a medicines competency assessment to check their competency at administering people’s medicines safely.

This was a comprehensive inspection that was carried out to check on the provider's progress in meeting the improvements required as a result of our inspection on 10 and 11 May 2016; when breaches of legal requirements were found in relation to staff recruitment, consent, notifications and clinical governance. Following that inspection, the provider sent us an action plan detailing how and by when they would meet the regulatory requirements. At this inspection, we found requirements in relation to: clinical governance, notifications and consent had been met. Requirements in relation to workers had been met in accordance with the provider’s action plan. However, this improvement had not been sustained and the provider continued to be in breach of this regulation at the time of the inspection.

The service had a 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. The registered manager was also the provider; throughout this report they will be referred to as the provider.

At our previous inspection in May 2016, we found the provider’s recruitment procedure did not ensure that staff employed were of good character. At this inspection we found the provider had taken measures to ensure the staff recruitment files for those staff employed at the previous information contained the required information. However, these improvements had not been sustained or embedded into practice for new staff, nor had safe recruitment practices been followed.

People told us there were sufficient staff to meet their needs and we found there were enough staff. People’s individual risks had been assessed and measures were in place to manage them safely. The provider had not ensured that all relevant service safety records were available for review at the time of the inspection, to provide written evidence of the checks completed, they have since requested copies of these documents.

People were protected from the risk of abuse, because staff understood and followed the correct procedures in order to identify and report any safeguarding concerns.

The provider had carried out a mental capacity assessment for people in relation to the application to deprive them of their liberty, and was able to show how decisions had been taken in people's best interests. The provider had informed CQC as required regarding applications to deprive people of their liberty.

Staff underwent an induction to their role, to ensure they had the required skills to work with people effectively. Further work was needed; to ensure that all staff were up to date with their required training and were appropriately supported in their role, when providing people’s care, through regular supervision and an annual appraisal of their work.

People were happy with the meals provided, which staff involved them in choosing. Staff had a good understanding of the risks associated with eating for each person and how these were managed. People were supported by staff to meet their healthcare needs.

People told us staff were kind and caring towards them and we observed they enjoyed positive relationships with the staff who provided their care. Staff were provided with a good insight into each person and their preferences to support them in providing people with individualised care. Staff were observed to involve people in making choices and decisions about their care provision. People told us staff respected their dignity. Staff were observed to provide people’s care in a manner that promoted their privacy and dignity.

People told us staff knew them well. Since the last inspection the provider had completed new care plans for each person which were now presented in a clearer format. There was evidence people’s care was reviewed with them. People were sufficiently stimulated and their independence was promoted.

The provider sought people’s views on the service and took action in response to any issues raised. People were aware of the complaints service and how to make a complaint if required.

Processes were in place to audit the safety of the service and to identify any required actions; any issues identified, had been rectified for people’s safety. The provider was in the process of updating their policies to ensure they all provided staff with up to date and relevant guidance.

People and staff liked the provider and found them to be approachable. The provider was the only manager and was stretched in their capacity to fulfil their role and duties. As a result, they had not been able to ensure that all of the improvements made had been sustained and embedded as required for people. They were exploring options for increasing the support available to them to ensure they could carry out their role fully.

Staff understood the purpose of the service. People were central to the care provided. The provider had monitored the culture of the service and taken action when they had noted that action was required in relation to staff morale for people.

We found one continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Mayfield House Care Home is a residential care home providing accommodation and support for up to twelve people with learning disabilities situated on a main road in Liphook in Hampshire. At the time of our inspection five people were living at the home. The home is a two storey building with communal areas located on the ground floor and with outside space in the form of a secure garden.

The home had a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service is required by a condition of its registration to have a registered manager.

During our inspection we found the provider had not followed safe recruitment procedures to ensure staff were suitable for their roles. The required pre-employment information relating to staff employed at the service had not always been obtained when staff were recruited.

Care and support plans and risk assessments contained information which was personalised to the individual. Risks associated with people's care and support needs had been identified and guidance was provided to help staff protect people from harm. People’s care records and risk assessments were regularly reviewed by the registered manager, however any changes were not always recorded. This meant that staff who were new to the service may not necessarily have all the up to date information they would need in order to quickly understand the risks to people's health and welfare and provide people with care which met their needs.

People’s safety was not always assured as the provider had no environmental risk assessment in place. There were no personal evacuation plans and business continuity plan to ensure people’s safety in the event of an emergency. Although the manager was able to explain how an emergency situation would be managed, as none of this was documented it was not clear that staff would know what to do in the registered manager’s absence.

New staff starting on their induction undertook the Care Certificate. The Care Certificate sets out learning outcomes, competencies and standards of care that care workers are nationally expected to achieve. Staff received training to support them to effectively meet the individual needs of people, although it wasn’t clear that all staff had undergone all mandatory training or that this was regularly refreshed to keep people’s knowledge and skills up to date. The provider had not always sought evidence that staff had undergone relevant training at previous employment, so in some circumstances if was not clear, for example, that staff administering medicines had been effectively trained to do so. Staff told us that they felt supported to carry out their roles and told us that they received regular supervision (one to one meetings with their manager). However, we could not always see that this was the case from the records we viewed. We have made a recommendation to support the provider to improve staff training, support and supervision.

People can be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA) 2005. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). During this inspection we found where people lacked the capacity to agree to the restrictions placed on them to keep them safe, the provider made sure people would have the protection of a legal authorisation and had made the appropriate DoLS applications to the local authority. However, we could not be assured that opportunities and appropriate support had been provided to ensure that people’s rights under the Mental Capacity Act 2005 had been upheld. The registered manager had not carried out a mental capacity assessment for people prior to applying to deprive them of their liberty, and was not able to show how decisions had been taken in people’s best interests. There was a risk that people's rights might not be upheld and restrictions might be placed on people unlawfully.

Effective governance and record keeping systems to monitor the quality of the service and identify the risks to the health and safety of people were not in place. Some audit checks were used but these were not robust enough to identify issues or concerns so that action could be taken to improve the quality of care people experienced and to ensure their safety.

We found that records were often not available for view, for example we were not able to see all the minutes of staff meetings we asked for. In some cases we found that records were not in place at all, for example medicines competency checks or documents to provide oversight of falls, accidents or incidents occurring in the home. A lack of effective record keeping meant that the registered manager was not always in a position to ensure the quality and safety of the services they were providing to people and to actively identify and mitigate any risks to people.

Mayfield House Care Home provided person-centred care. This meant that staff understood the needs of each individual and provided care accordingly. People, relatives and staff views about the management of the service were positive. People and staff spoke positively about the registered manager. They told us that the registered manager was approachable and listened to them. Opportunities were available for people, their relatives and professionals to provide feedback about the service. People’s views and comments were listened to and acted on, and relatives had input into people’s care.

People were spoken to with kindness and patience, and were offered choice in their day to day lives. People were encouraged to maintain their independence by helping out with daily tasks if they wished, such as gardening and helping in the kitchen. Staff knew and understood the personalities, behaviours and needs of each person well. They also understood how to promote people’s dignity and respect.

People had prompt access to healthcare services when they needed them and the registered manager was quick to respond to changes in people’s health. People liked the food provided at the home and received the support they needed to eat and drink enough.

The registered manager took action to notify safeguarding concerns appropriately. People were safeguarded from the risk of abuse, because staff understood how to identify and report concerns.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

On the day of the inspection six people were living in Mayfield House Care Home and we spoke with five of them. During our inspection we also spoke with the registered manager, two senior care workers, two care workers, a care manager, two people's relatives and another person's representative.

This is a summary of what we found;

Is the service safe?

One person's relative told us, 'They couldn't be in a better place. The people get on so well and you can tell they are real friends. They always tell staff if someone is upset or unwell.' Another relative told us, 'People are safe because the staff know everyone so well. Most of the people have been there a long time and the manager is very caring.'

We found that people had been cared for safely. People's needs had been assessed and reflected in their care plans. Where necessary, risk assessments had been completed which identified and reduced risks to people, whilst supporting them to remain independent.

Where people needed support with more complex health needs we saw there were specific health care plans which detailed the care people needed and how staff should provide this. We found that staff had received appropriate training in relation to meeting people's complex needs, which had ensured that people's needs were met safely.

People were protected from the risk of inappropriate or unsafe care because the provider had an effective system to identify, assess and manage risks to their health, safety and welfare. We found that the provider had reviewed people's care plans to reflect changes in their needs.

We noted that the registered manager had ensured that people had been protected from the risks of financial abuse by completing applications to the Court of Protection to designate appointees to manage their financial affairs.

The provider had an effective process to manage medicines safely. During our inspection we observed a care worker administer medicines safely, in the way people preferred, which had been detailed within their medication care plan.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the location to be meeting the requirements of the DoLS. Whilst no applications had been submitted, the manager was reviewing whether any applications needed to be made in response to the recent Supreme Court judgement in relation to DoLS.

Is the service effective?

We found that the service had effectively managed people's nutritional and hydration requirements. Where necessary people had assessments and plans completed by speech and language therapists. We saw people were supported to eat a healthy balanced diet by staff who had been trained regarding nutrition and food safety.

Care practices we observed demonstrated that staff knew the needs of people and how to communicate with them. We found that people's independence had been promoted and they had been supported to pursue their interests and activities.

Where people had the capacity to make decisions about their care they had been supported to do so. Where people lacked the capacity to make specific decisions the provider had assessed this and was following the correct legal processes to make decisions in people's best interests.

Is the service caring?

We found the service was caring. People were supported by kind and compassionate staff, who spoke with people in a friendly and respectful manner. We saw that care workers gave encouragement to support people who were able to do things at their own pace.

One person told us the staff, 'Make me happy and always talk to me.' Another person said, 'They take me out to do what I want to do.' A relative told us, 'It is such a warm and homely place. The staff are excellent and the manager is always available if you have any queries.'

Is the service responsive?

We saw evidence that when people's care needs had changed the service had been responsive to this. They had recognised changes in people's needs and engaged other services to ensure appropriate actions were taken to meet these.

We found that the service had swiftly identified when people's health had declined and had responded by ensuring relevant health professionals had been consulted and short term specific care plans had been created and implemented. In March 2014 we found the manager had responded quickly and implemented appropriate measures to prevent the spread of an infection within the service.

The registered manager operated systems to deal with comments and complaints which had been understood by people, well-publicised and reflected principles of good complaint handling. The complaints system was readily accessible to people in a format which met their needs. This ensured staff listened to their concerns and responded to them effectively.

Is the service well-led?

The service had a registered manager in place and staff told us that the service was well led. One care worker told us, 'The manager has vast experience and talks to us in a friendly manner if she sees something which is not right.'

A care manager told us that the registered manager had recently effectively engaged with local authority disability nurses and had readily implemented their suggestions to improve care practice.

We found there were processes and systems in place to monitor the quality of the service provided. We saw evidence that the registered manager had completed various audits in relation to the service. These included infection control, control of substances hazardous to health (COSHH), medication and health and safety. We saw evidence from the health and safety audit for example, that where issues had been identified action had been taken to address them. This meant that there were processes in place to audit the quality of the service and to take action where required.

As a result of our inspections we issued a warning notice telling the provider to take action by 17 January 2014. On 19 March 2014 we carried out a further inspection of the home to assess whether the home had completed the action required.

During our inspection we spoke with two members of staff and asked them what they understood by the terms safeguarding and whistleblowing. Both demonstrated that they had an understanding of the behaviours that would constitute abuse. They told us that they had discussed the updated safeguarding policy with the registered manager in a supervision meeting.

We saw that flooring had been replaced in two bedrooms and an ensuite bathroom. The new flooring was easy to clean and this meant that the unpleasant odour previously noted had disappeared. This meant that the ensuite bathroom and the two bedrooms provided a pleasant environment and were suitable for people who used the service.

One person using the service required the assistance of a hoist and a wheelchair. We saw records which showed that the equipment had been serviced regularly by a specialised company. This meant that the equipment was safe and suitable for its use.

We saw that the broken pane of glass in the laundry room, previously identified as a risk, had been replaced. Although a test for legionella had been carried out, a risk assessment in respect of legionella had not been completed. Appropriate actions to mitigate the risks associated with legionella had not been completed.

We saw that damaged furniture, previously identified as a risk, had not been repaired or replaced. This meant that people who use the service were not protected from using unsuitable equipment.

People's care was planned and delivered in line with their needs. We spoke with the relatives of two people. One told us that the staff were all lovely and that they had never had any concerns. The other told us 'the care is quite good. ' One person who lived in the home said 'I enjoy living here ' I want to always live here'

People were not protected from the risk of abuse because staff were not trained to recognise and report potential abuse. Staff were not given a way to report abuse outside the management of the home.

During our inspection we saw that the laundry room had a broken pane of glass. This meant that the laundry room was not safe for either people using the service or staff.

Staff were supported to deliver care and treatment. Staff told us they felt well supported in their role and that they had regular supervision meetings with the registered manager.

People who use the service were asked for their views about their care. In May 2013 a service user satisfaction survey was carried out which asked people about the way they were treated and the quality of the care they received. Everyone who used the service answered 'good' or 'very good' to the questions.