Mayfield House

Updated 10 June 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors and a nurse specialist advisor.

Service and service type

Mayfield House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Mayfield House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post. However, they were on a planned period of absence and there was an acting manager in place.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority about the service and used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We also used information gathered as part of monitoring activity that took place on 14 March 2022 to help plan the inspection and inform our judgements. We used all this information to plan our inspection.

During the inspection

We spoke with nine people who used the service about their experience of the care provided and three relatives. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with 13 staff members including care assistants, domestic staff, the maintenance person and the cook. We also spoke the acting manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. These included seven people's care records and medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 10 June 2022

About the service

Mayfield House is a purpose-built residential care home providing personal care for up to 51 people. The service provides support to older adults and those living with dementia. At the time of our inspection there were 40 people using the service. Mayfield House accommodates people across two separate units, one of which specialises in care to people living with dementia.

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

We could not be assured people had received their medicines as prescribed. Systems in place to ensure the proper and safe management of medicines were not sufficiently robust. The provider’s efforts to address errors/discrepancies had not been effective. We referred these concerns to the local authority for further support.

Staff took some action to reduce potential risks to people. However, risk assessments did not always include enough individualised information about the support people needed to mitigate risks and some risk assessments were not in place where required.

The provider’s governance and oversight systems were not always effective. Despite their audits identifying areas which required improvement, they did not highlight all the issues we found during the inspection.

The premises were safe. However, fire evacuations which considered minimum staffing levels needed to be carried out. Following the inspection, the manager confirmed how they would address this.

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. Whilst the provider had processes in place for capacity assessments and best interest decisions to be made, gaps in staff knowledge had resulted in these not always being completed correctly in line with the MCA. We have made a recommendation about this.

There were enough staff to respond to peoples' needs during the inspection, however staffing levels varied at times. The provider was unable to demonstrate safe staffing numbers had been established based on the needs of the people being supported. The provider had recruited some new staff and was continuing to recruit. Staff were recruited safely. During the inspection, the management confirmed they would increase staffing numbers and would source a more effective dependency tool.

People were supported by familiar staff who understood their needs and respected their choices and preferences. However, care plans did not always contain enough information to guide staff about people’s care needs, taking account of their individual preferences.

People told us they felt safe living at the home and overall were complimentary about the support they received. Appropriate safeguarding arrangements were in place. Staff received appropriate training and support.

Relatives were positive about the communication at the service and felt well informed. Visiting was taking place in line with government guidance. A new activities coordinator was due to start at the home.

The provider had a quality improvement plan in place which was updated following the inspection to address the issues we identified. Since the last inspection the provider had made some improvements in relation to the management of complaints, some refurbishment of the premises and they planned to implement new electronic recording systems. Managers were responsive and keen to address any areas identified for improvement.

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 17 October 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement.

Why we inspected

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

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report. The provider has taken some immediate actions and provided an action plan. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mayfield House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the safe management of medicines, management of risk and good governance at this inspection. We have made a recommendation in the effective section of this report.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.