Archived: Mayfield House

Mayfield House is a residential care home providing personal care to seven people at the time of the inspection. The service can support up to 20 people.

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

The provider had recognised the service provided was not in line with the values that underpin the ‘Registering the Right Support’ and other best practice guidance and was finalising the development of a supported living service for the people living at the home to move to which would support these values. The values of ‘Registering the Right Support’ include choice, promotion of independence and inclusion to make sure people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support. People had not been supported to maintain person centred care plans to reflect their goals and aspirations. There was little evidence that people had been supported to develop and follow a programme of activity meaningful to them.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. For example, a condition on one person’s Deprivation of Liberty Safeguards (DoLS) was for the service to look at technology to reduce the level of staff observation. This had not been done.

Systems of governance and oversight were not sufficiently robust to have identified the issues we found during the inspection.

Staff were safely recruited and received the training and support they needed to undertake their role. However, our observations of practice evidenced that training might not always have been effective. The provider increased staffing levels following our feedback on the day of the inspection.

We have recommended the provider maintains an on-going review of staffing levels in accordance with people’s needs and assesses the effectiveness of staff training through observation and supervision.

People said they felt safe and would speak to a member of staff if they were not happy about something.

The service had appropriate checks and maintenance to ensure the service and equipment was safe for the people living at Mayfield House.

Assessments of people’s needs were in place, but care records did not always show the care and support being delivered met with people’s assessed needs.

We have recommended the provider audits care plans to make sure up to date healthcare information is included.

People spoke fondly of staff and we observed some caring interactions between staff and people who used the service.

More information is in the full report.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to need for consent and good governance. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection and update: The last rating for this service was requires improvement (published 12 June 2018) and there were three 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 had achieved compliance with two of these breaches but remained in breach of regulation 17 (Good governance).

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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Mayfield House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The provider had recognised that the service provided was not in line with the values that underpin the ‘Registering the Right Support’ and other best practice guidance and had plans in place to develop a supported living service for the people living at the home to move to which would support these values. The values of ‘Registering the Right Support’ include choice, promotion of independence and inclusion to make sure people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager but they were not available at the time of the inspection.

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 the last inspection on 10 February 2016 we rated the service as ‘Good’ and there were no regulatory breaches.

Prior to this inspection we were informed of changes in relation to the provider’s senior personnel and that an initial audit carried out by the new operations manager had identified issues of concern. We brought this inspection forward as a result of this information.

We found appropriate and timely action had been taken to make sure the environment was safe.

People told us they felt safe and staff understood their responsibilities in relation to protecting people from abuse.

Risk assessments and behaviour protocols were in place but were in need of effective review.

Medicines were managed safely and infection control systems were in place to keep people safe.

Staff recruitment procedures ensured staff were suitable to work in the care service. Staffing levels were sufficient and flexible to meet people’s needs.

The training matrix showed gaps in some staff’s training which meant not all staff had received the training they needed to support them in their roles. Not all staff felt they received effective support.

People accessed healthcare services as required. However we found the advice of healthcare professionals was not always incorporated into care plans or followed.

Although we observed people were offered choice, care plans did not support the ethos of supporting people to have maximum choice and control of their lives.

We recommended consent issues be reviewed to make sure the service is working within the principles of the MCA.

People told us they enjoyed the meals at the home and we saw they were involved in developing menus.

We saw staff were caring in their approach and had developed positive relationships with people and clearly knew them very well.

Care plans did not did not reflect any involvement of the person concerned and did not always reflect a caring or positive approach, with some appearing judgemental rather than demonstrating how caring practice was embedded and promoted within the service.

We saw staff supported people well with personal care but found people’s dignity needs were not always fully considered.

Improvements were needed to demonstrate a person centred approach to care planning.

People were involved in a wide range of activities but we did not see evidence of people’s choices with regard to activities being reviewed. People were supported to choose and enjoy an annual holiday.

Systems for auditing were not robust and although issues with governance had been identified, this had been as a result of changes of personnel and not through continuous monitoring of the quality and safety of the service.

We identified three breaches of regulation. These were in relation to safe care and treatment, staff training and support and good governance. You can see what action we have told the provider to take at the end of the full version of this report.

Mayfield House is a converted property which provides accommodation and personal care for up to 20 people with a learning disability. It is located in the King Cross area of Halifax and is close to local shops and amenities.

At the time of our visit there were 15 people using the service.

There is 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.

People told us they felt safe in the home. Staff had a good understanding of how to control risks to people’s health, safety and welfare.

Staff were recruited safely and there were enough staff on duty to provide people with the care and support they needed. Staff had received appropriate training, supervision and support.

We saw staff knew people well and there was a warm and good humoured atmosphere in the home. People were supported to follow their interests in the community and a wide range of activities. Staff supported people to be as independent as possible and we saw people going out on their own or helping with cleaning and laundry.

Care and support plans were individualised and focused on what each person wanted to achieve and what support they required from staff.

We found people had access to healthcare services and these were accessed in a timely way to make sure people’s health care needs were met. The medication system was well managed and people received their medicines at the right times.

People told us meals were good and we saw the menus provided both choice and variety.

Mayfield House was well maintained and homely. People’s bedrooms were highly personalised and we found everywhere was clean and tidy.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).

We saw there were systems in place to monitor the quality of the service. When areas for improvement were identified action was taken to address the shortfalls. People using the service were asked for their views and staff responded to their requests.

We visited the home over two days, on 30 December 2013 and 2 January 2014. On the days of our visit there were fifteen people living at Mayfield House. Accommodation was on the ground and first floor of the property with separate accommodation in the 'cottages' to the rear of the house. There was both a stair-lift and a passenger lift available for people to access the first floor of the main house.

We spoke with the manager, two senior care staff, three care staff and the housekeeper. All the staff that we spoke with were helpful, pleasant and co-operative.. We also looked at the support plans of five people who lived at Mayfield House.

We spoke with five people who lived at the service, their feedback was positive. There comments included:

'I'm generally happy; I've not been upset by anything.'

'The food is alright here....I choose what I want...but I like any food.'

'(It's) good here, very good.'

People we spoke with told us they had regular contact with relatives and access to the local community. Each of the support plans we looked at contained a monthly summary of the daily entries staff made about a person's care and support. These included their social and family contact and leisure activities.

The support plans we looked at were person centred and included detailed information about the support people required and their personal preferences.

Staff who worked for the service were aware of how to raise concerns about abuse and recognised their personal responsibilities for safeguarding people using the service.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. We looked at three training files and saw they included mandatory training and other training to ensure the staff had the skills to meet the needs of people who used the service

Information showed the service had a range of systems in place to help determine the quality of service the home offered. We were told by the manager, monthly meetings were held with people who used the service. We saw people were asked their opinion and were asked to make choices relating to their involvement in the running of the home.

'I like living here and I like the staff.'

'I like my bedroom.'

'I've been on holiday and I've had a good time.'

'I've been out today to play bingo.'

'The food is good.'