Archived: The Mayfield

The Mayfield is a residential care home providing personal and nursing care to 22 people aged 65 and over at the time of the inspection. The service can support up to 23 people in one adapted building.

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

We were not assured the provider had fully managed potential risks to people living at the home. One person’s individual risk assessment and care plan had not been updated to reflect their current needs. We found gaps in the records for weekly testing of the home’s fire alarm system. The home’s laundry room was left unlocked and unstaffed during our inspection which meant there was a risk people could access laundry and other hazardous materials and liquids. We observed gaps under three fire doors that had not been identified by the provider’s recent fire risk assessment.

People’s medicines were safely stored and administered to people at the correct time. Staff wore appropriate personal protective equipment (PPE) in accordance with current guidance for care homes. The provider was in the process of reviewing and updating people’s individual risk assessments. They had developed a risk assessment to ensure people’s safety was maintained during a refurbishment of the home.

The provider had carried out pre-recruitment checks on staff staff to ensure they were suitable for their roles. Staffing at the home was sufficient to meet people’s needs at the time of this inspection. The provider had deployed additional staff to ensure people were fully supported during the home’s refurbishment. Staff received training in a range of mandatory areas, and this training was refreshed annually.

People’s individual needs were assessed prior to their moving to the home. The provider had a policy of regular reviews of care plans and risk assessments. However, we found these were not always updated to reflect people’s needs. People’s care plans and risk assessments were being reviewed and updated at the time of our inspection, but this work had not yet been completed.

People received support with their health care needs, and we saw recorded evidence of health appointments and referrals. Professionals such as GPs and district nurses regularly visited people living at the home. People ate a healthy diet and were able to choose their meals. Cultural and specially prepared foods were provided to people where they required 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.

The provider had systems in place to monitor the quality of care and safety of the service provided to people. However, this had not always identified and acted on potential risks to people. At the time of our inspection the provider was working to improve the quality of their monitoring of the home.

People and their relatives told us they were satisfied with the care and support they received. They spoke positively about the registered manager and staff.

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

Rating at last inspection

The last rating for this service was good (published 6 July 2021).

Why we inspected

We received concerns received in relation to safety, hygiene, record keeping and staffing. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

Enforcement

We have identified one breach in relation to the management of risk.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Mayfield is a residential care home providing personal and nursing care to 22 people aged 65 and over at the time of the inspection. The service can support up to 23 people in one adapted building.

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

When we inspected The Mayfield there was an outbreak of COVID-19 at the home. The registered manager had worked with the commissioning local authority and specialist infection control specialists to ensure that people were supported as safely as possible whilst isolating. Additional staffing had been provided to ensure people received the support they required. We found the home was clean and well-presented and staff were following current guidance in relation to the control and prevention of infection in care homes. Infection control nurses had visited the home regularly to provide training and support to staff. All staff, including agency staff had received regular testing for COVID-19.

At our previous inspection of the home we found that cupboards in the kitchen were smeared and some laundry fluids were not safely stored. At this inspection we saw that the provider had taken action to address these issues.

People’s medicines were stored and administered safely. Staff administering medicines had received appropriate training and assessments of their competency.

The home had carried out regular risk assessments of people, premises and care practice. These had been regularly reviewed and updated when there were changes.

Staff were recruited in a safe way. Appropriate checks, including checks of references and criminal records had been carried out prior to appointment.

The home’s policies and procedures were regularly updated and reflected best practice and current guidance for care homes. Regular quality assurance monitoring had been carried out and actions had been taken to address any concerns. People and their family members had been asked for their opinions about the care provided at the home.

The registered manager had worked in partnership with other professionals to ensure people received the care and support they required.

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

Rating at last inspection

The last rating for this service was Good (Report published 7 June 2019).

Why we inspected

This was a focused inspection carried out due to an outbreak of COVID-19 at the home.

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 found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well-led sections of this full report. The provider had taken effective action to mitigate risks to people.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Mayfield is a residential care home that provides accommodation and personal care for up to 23 older people, some of whom are living with dementia.

At our last inspection of the Mayfield in September 2017 the home had failed to ensure that people’s needs were always met. During this inspection we found that the registered manager had acted to address our concerns.

People’s experience of using this service:

People and their family members told us they were happy with the care and support that they received. They spoke positively about their care workers and the home’s manager.

The registered manager had carried out checks of safety and quality at the home and had acted to address any concerns arising from these. However, on the day of our inspection we saw that the home’s kitchen’s cupboards and work surfaces had not been recently cleaned. The home’s laundry room which was used to store cleaning fluids and other potentially hazardous substances did not have a working lock. The registered manager took action to address these concerns during and immediately following our inspection.

Care and support was person centred and reflected people’s individual needs. People’s care plans and risk assessments had been reviewed regularly and updated where there were changes in their needs.

Staff members were knowledgeable about people’s needs and how these should be supported. They understood their roles and responsibilities in ensuring that people were kept safe from harm or abuse.

Staff engaged with people in caring and considerate ways. They ensured that people’s dignity and privacy was maintained sensitively.

People had been supported to make decisions about their care and support where they were able to do so. Information about people’s capacity to make decisions had been recorded in their care files. Applications for authorisations under the Deprivation of Liberty Safeguards (DoLS) had been made to ensure that people were not unduly restricted in any way.

Staff at the home ensured that people were supported to engage in activities. These generally took place within the home but the registered manager told us that, during the summer months some people went out to local parks and other places of interest.

Staff had been safely recruited. The registered manager had carried out checks of their suitability to perform their roles before they commenced work. Staff had received training in relation to their work when they started working. This was ‘refreshed’ on a regular basis. Staff had also received regular supervision from the registered manager to ensure that they were competent and effective in their roles.

People told us that they liked the food that they were offered and were able make alternative choices if they wanted something else.

Staff at the home supported people’s cultural needs and preferences. Cultural information and food was provided to people and staff were able to interpret information for people where required.

The home liaised with other health and social care professionals to ensure that people’s needs were met.

Rating at last inspection:

Requires Improvement. Report published 20 March 2018. The overall rating for the service has improved since our last inspection.

Why we inspected:

This was a planned comprehensive inspection.

Follow up:

We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

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

At our previous inspection of the service in on 22 July 2016 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to need for consent and safe care and treatment. Following this inspection the provider sent us a plan which set out the actions that they were planning to take to address these. During this inspection we found that the provider had taken steps to improve the service in order to meet the requirements identified at the previous inspection.

The Mayfield is a care home situated in Kenton which is registered to provide accommodation and personal care to up to 23 older people. At the time of our inspection there were no vacancies. The majority of people at the home were living with dementia.

There was 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 who lived at the Mayfield told us that they felt safe. This view was confirmed by family members whom we spoke with.

Although the home was meeting some of the requirements of the Mental Capacity Act 2005 (MCA we found that they had not always followed MCA guidance and principles, Where bed rails were in place for people who were unable to give consent to this, there was no record that decisions had been taken in their best interests and that bedrails were the least restrictive option for them.

Bathrooms at the home had not been regularly maintained, creating a risk of infection. We found that some toilet seats and tiles were chipped or broken and there was an accumulation of dust in a communal bathroom,

The care plans for people living at the home were person centred and provided guidance for staff about how people wished to be supported. The plans were reviewed and updated regularly to ensure that they addressed people’s current needs. However, we found that these reviews had not always identified where actions relating to people’s care and support had failed to be carried out.

People living at the home had person centred and up to date risk assessments to ensure that they were kept safe from avoidable harm. The risk assessments contained detailed guidance for staff on managing risk to people. We saw that these were regularly reviewed. However, we found that some information in relation to management of risk was not easily accessible in people’s care records.

The provider had put a range of processes in place to improve the quality of care provided to people living at The Mayfield. However, we found that these had not always identified or addressed issues in relation to ensuring that people were safe. Monthly reviews of care plans and risk assessments had not identified gaps. There was no system in place to ensure that changes in people’s weights were fully recorded and actions taken where there were concerns. Maintenance and cleanliness issues in relation to bathrooms had not been identified nor dealt with.

Staff members had received training in ensuring that people were safe, and were able to demonstrate their understanding of what this meant for the people they were supporting. They were also knowledgeable about their role in ensuring that people were not at risk of abuse and understood how to report and record any concerns that they had about people's well-being.

Checks had taken place as part of the staff recruitment process to ensure that staff were suitable for the work that they would be undertaking at the home. The staff who worked at the home received training which was ‘refreshed’ on a regular basis. All staff members received regular supervision from a manager. The staff members that spoke with were knowledgeable about their roles and responsibilities and told us that they felt well supported.

We looked at the support that was provided to people living at the home and found that were enough staff members on duty to meet their needs. Staff supported people in a caring and respectful way, and responded promptly to needs and requests. People who remained in their rooms for all or part of the day were regularly checked on.

There were arrangements in place to ensure that people’s medicines were stored, managed and given to them appropriately. Staff members who were responsible for administering medicines had received appropriate training and we saw that regular competency checks were carried out.

People and their family members told us that staff were caring. We observed positive interactions between people and their care staff. We saw that people were offered choices and that their dignity and privacy was respected.

The home provided individual and group activities for people to participate in throughout the week. People’s cultural and religious needs were supported by the service and a faith representative visited the home on a regular basis.

People told us that they liked the food at the home. The meals that were provided met individual health and cultural requirements. Alternatives were offered where people did not want what was on the menu. People appeared to enjoy their meals. Drinks and snacks were offered to people throughout the day.

There was a complaints procedure at the home. People and their family members that we spoke with knew how to complain if they had a problem with the service.

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

At our previous inspection of the service in on 21 July and 11 August 2015 we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to person centred care, safe care and treatment, safeguarding people from abuse, and good governance. During this inspection we found that the provider had taken significant steps to improve the service in order to meet the requirements identified at the previous inspection.

The Mayfield is a care home situated in Kenton which is registered to provide accommodation and personal care to up to 24 older people. At the time of our inspection there were no vacancies. The majority of people at the home were living with dementia.

There was 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. The registered manager at the home had recently taken on the management of another service. Although we spoke with them during our inspection, a new manager had been appointed who was leading the day to day management of the home. The new manager had commenced the process of applying to The Care Quality Commission for registration.

People who lived at the Mayfield told us that they felt safe. This view was confirmed by family members whom we spoke with.

Staff members had received training in safeguarding, and were able to demonstrate their understanding of what this meant for the people they were supporting. They were also knowledgeable about their role in ensuring that people were safe and that concerns were reported

appropriately.

People had person centred and up to date risk assessments to ensure that they were kept safe from avoidable harm. The risk assessments contained detailed guidance for staff on managing risk to people. We saw that these were regularly reviewed.

The provider had arrangements in place to ensure that people’s medicines were stored, managed and given to them appropriately. Staff members who were responsible for administering medicines had received medicines training, and we saw that regular competency checks were carried out. However, when we observed a staff member administering medicines, we saw that they sometimes recorded that medicines had been given prior to taking the medicines to the person. This meant that we could not be sure if records always reflected whether or not the person had taken their medicine.

We also noted that the staff member placed the medicines into an un-gloved hand prior to putting them in a container to give to each person. They did not wash their hands between giving medicines to each person. Although we saw some good practice, such as staff wearing disposable aprons and gloves for other tasks we identified a further concern in relation to infection control at the home. Following lunch we saw a staff member using a cloth to wipe a person’s face. They then went on to wipe another person’s face with the same cloth. Although the provider had infection control measures in place we could not be sure that these were always followed.

There were enough staff members on duty to meet the physical and other needs of people living at the home. Staff supported people in a caring and respectful way, and responded promptly to needs and requests. People who remained in their rooms for part of the day were regularly checked on.

Staff who worked at the service had received relevant training and were knowledgeable about their roles and responsibilities. Appropriate checks took place as part of the recruitment process to ensure that staff were suitable for the work that they would be undertaking. All staff members received regular supervision from a manager, and those whom we spoke with told us that they felt well supported.

We found that the home was not always meeting the requirements of The Mental Capacity Act 2005 (MCA). Applications for Deprivation of Liberty Safeguards (DoLS) had been made to the relevant local authority. Staff members had received training in MCA and DoLS. However, although care plans identified whether or not people had capacity to make certain decisions, no assessments of capacity had been undertaken. Where bed rails had been put in place for people, there was no record of whether this was in their best interest or the least restrictive option available to keep them safe as required by the MCA.

People told us that they liked the food at the home. Meals that were provided met individual health and cultural requirements. Alternatives were offered where people did not want what was on the menu. People appeared to enjoy their meals. Drinks and snacks were offered to people throughout the day. Health professionals were involved where there were concerns about appetite or maintenance of weight.

People’s care plans were person centred and provided guidance for staff about how people wished to be supported. The plans were reviewed and updated regularly to ensure that they addressed people’s current needs.

People told us that staff were caring and we observed positive interactions between people and their care staff. People told us, and we observed that they were offered choices and that their privacy was respected.

The home provided individual and group activities for people to participate in throughout the week. They had recently started to provide outings outside the home and we were told that further outings would take place. People’s cultural and religious needs were supported by the service.

People and their family members that we spoke with knew how to complain if they had a problem with the service.

Care documentation showed that people’s health needs were regularly reviewed. The service liaised with health professionals to ensure that people received the support that they needed.

There were systems in place to review and monitor the quality of the service, and we saw that action plans had been put in place and addressed where there were concerns. Policies and procedures were up to date and staff members were required to sign that they had read and understood any new or amended ones.

People who used the service, their relatives and staff members spoke positively about the management of the service. They told us that they liked the new manager.

We found two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People who spoke with us said they enjoyed living at the home. We were told "I have lived here a couple of years and you can't fault them, the are caring, attentive and very friendly."

We observed that the home was quiet with a friendly, relaxed and homely atmosphere.

We saw there was information for people in the reception area of the home so that people were aware of the activities available. However we observed that no activities were offered during the morning of our inspection.

We observed that at lunchtime people were very social and interacted with each other during their meal. We saw that staff joined in the lunchtime meal creating a family atmosphere. People we spoke with told us that they enjoyed the food and could make

choices about meals.

We saw there were sufficient staff on duty to meet the care needs of people who used the service. The staff we spoke with had a very clear understanding of the care needs of people who lived in the home.

We saw that people were treated with respect and dignity, ensuring that people were supported to maintain their independence as much as possible. One person told us "I do for myself what I am able to do, but it's nice to know the staff are there."

We found that staff were appropriately trained in the administration of medicines, but controlled drugs administration records were not kept properly.

The provider checked to ensure it was providing a safe service that provided for people's needs. However, it was not possible to see if changes had been made to the way the provider did some of its checks and audits.

All the people we spoke with told us they were happy with the care they received and got the support they required. One person said the home was: "quite pleasant." However, three of the people we spoke with said the food could be improved. We found and observed that people were assessed and that care was provided was safely.

People told us that they were happy with the home and with their rooms. One person said their room was: "pleasant." Although the provider had taken steps to check the premises were safe, parts of the premises were unsafe.

All the appropriate checks had been made to ensure that staff were suitably qualified to provide care to people safely. Although some staff did not have up to date training, the provider had further training scheduled to ensure that staff would be up to date.

Two people we spoke with said they had not been given a survey about the care they received. However we saw evidence that the provider met and surveyed regularly with both staff and people who use the service to obtain their feedback regarding where the service could improve. The provider carried out regular checks to monitor the service but these checks did not always identify the risks to people.