Mayfield Road

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We assessed all the quality statements within this key question. Our rating for this question has improved to Good. However, we found improvements were required to ensure staff’s understanding of the Mental Capacity Act 2005 and ensure detailed records were maintained about people’s capacity to consent. Relatives also found that communication needed to improve to ensure they were informed in a timely manner about any health appointments their family member needed to attend, and ensure staff were able to share detailed information about people’s needs with healthcare professionals. Processes to assess people’s care and support needs had improved and people were now receiving support from their key worker to focus on skill development and goal attainment.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most family members told us staff understood their relatives well and that they knew what was important to them. Comments included, “Sometimes [staff] know [my relative] better than I do.” Family members praised staff for being a “good influence” and encouraging a person to build social skills to avoid loneliness and social isolation.

People’s care needs were assessed before they started using the service. The registered manager told us that the new accommodation requests were carefully considered to ensure the service was able to meet the needs of the person being referred.

Processes were in place to assess people’s needs and these assessments were used to develop people’s care plans. Since our last inspection people’s needs had been assessed and care plans had been updated. These assessments involved people and their relatives, where able.

People received support to maintain a balanced diet and meet their personal preferences. Family members’ comments included, “[Staff] regulate [my relative’s] food better than we do”, “[My relative] likes traditional food so [staff] do that for him”, “There’s a certain way you have to [support my relative with eating]. [Staff] know how to do it” and “[Staff] have told me [my relative] has started to eat more fruit.”

Mealtimes were flexible and aimed at meeting people’s needs and preferences. Since the last inspection, a chef was employed to improve people’s mealtime experiences. A menu plan was developed around dishes that most people liked to eat as discussed at the residents’ monthly meeting. People were offered an alternative dish if they didn’t want to eat what was provided to them. Staff encouraged people to eat a balanced diet, and their meals were presented to them hot and in big portions. People were able to eat and drink in line with their cultural preferences and health care needs.

The provider took account of best practice guidance and they were piloting use of recognised support tools. There were also processes in place to involve specialist professionals in service delivery to ensure staff were supporting people in line with best practice guidance.

Family members felt involved in the planning of people’s care. They said, “The manager will write [the care plan] out then she sends it to us for corrections”, “[The registered manager] really made an effort to get families on board” and “I know where [my relative’s] care plan is kept if I wanted to see it.”

Systems were in place to ensure that information about people’s care was shared effectively at the service. Staff told us, “I read care plans, and we have a communication book to let each other know if any change to residents care is needed” and “We talk to each other and also read care plans which are good with providing information.”

Health professionals working with the service said there was good team working. They said communication was good and staff took on board advice and suggestions to ensure people’s health and care needs were met.

Systems were in place to ensure the staff team worked together to meet people’s needs. This included liaising with and working with other health and social care professionals when appropriate. The staff had worked hard to improve processes about joint working and information sharing with other agencies.

People were not always provided with effective support to attend their health appointments and to communicate their health-related needs to the family members. Family members told us, “I didn’t know anything about it and I got a call saying [my relative] needed surgery!”, “[staff] didn’t tell me! I found out, out of the blue that [my relative] needs to see a [name of the specialist]”, “There has been a couple of incidents. [My relative] went to the hospital with no red bag. As far as I know it’s okay now” and “As soon as I step back from [ being involved with healthcare appointments], it all goes pear shaped. [Staff] forget, or they take [my relative] to the wrong place, they’re too early, or too late and so on. It happens all the time.”

Despite the feedback from relatives, actions had been taken to improve communication and information sharing with healthcare professionals and family members, and the registered manager told us they continued to work on this. Any incidents related to people’s health care were investigated and acted upon to address any issues identified, such as staff’s performance and changes necessary to the systems and processes. The registered manager told us, “The aim is to have the right staff and in the right roles” to improve in this area.

Processes were in place to ensure people were supported to live healthier lives. This included recording regular checks, such as people’s weight. As well as development and adherence to people’s health action plans.

People’s care was aimed at their well-being. Family members told us that actions had been taken promptly to address their concerns. Regular reviews were carried out to ensure people received the necessary care.

Systems in place ensured people’s safety when alone. The registered manager told us that staffing levels reflected the needs of people the service supported. Seizure alarms and regular checks were in place and provided the on-going monitoring to ensure people’s safety when people were spending time on their own in their bedrooms. This also ensured that staff were being made aware quickly if a person had an epilepsy seizure.

Processes were in place to ensure regular key worker sessions were held to ensure people’s achievements and progress towards their identified goals.

People were encouraged to make their own decisions where they were assessed as having capacity to do so. This included a person managing their everyday expenses when they were outside in the community. The registered manager told us that people’s family members got involved helping them to make more complex decisions where they required such assistance. Another person had an independent mental capacity advocate for support when they needed it.

We asked staff how they applied the MCA in practice. Examples provided were in relation to the support people received with making choices. However, not all staff knew the importance of asking people for consent before they started providing care to them. This was also observed in practice when a staff member told a person that they were going for lunch rather than asking the person if they were ready to do so. Staff's limited knowledge of the MCA was discussed with the management team who reassured us that action would be taken to improve staff’s skills around the MCA.

Whilst there were processes in place to assess people’s capacity and consent. We found the detail recorded in people’s care plans were lacking. People’s ability to consent to day-to-day decisions and how they were supported to do this, was not always clearly recorded in people’s care records. The registered manager told us they would ensure people’s care records were updated with further detail regarding capacity and consent. Clear documentation was maintained regarding the use and authorisation of Deprivation of Liberty Safeguards (DoLS).