About the service: The service is a care home that provides personal care for up to 19 older people, some of who may be living with dementia. 18 people used the service at the time of our inspection.

People’s experience of using this service: Work was still required to improve the staff and provider’s knowledge and practice in key areas such as medication, Mental Capacity Act 2005 where there is continued recommendations in this report. In addition, fire safety, infection control and risk management. Staff understood the basics around how to keep people safe. Information following accidents and incidents was not recorded to evidence action taken to reduce the likelihood of future harm. Systems to check that people were receiving safe and good quality care required further development.

The provider had worked hard since the last inspection to make changes that impacted positively on people’s experience of using the service. Staff understood the vision the provider had to ensure people received high quality person centred care. People said staff knew them very well, could anticipate their needs and that support was delivered in a timely way. People described good provision of activities and events that were tailored to their needs. People were supported to maintain relationships and afforded support to develop and build new relationships. People and their relatives described high levels of satisfaction with the service which impacted positively on their overall wellbeing. A relative told us, "It is a very warm place, not clinical. As you walk through the door it is a home. We feel as a family this is a home from home."

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were treated with respect and dignity and their independence encouraged and supported. Where people required support at the end of their life, this was carried out with compassion and dignity.

The environment enabled people to have time on their own and time with other people if they chose this.

The registered manager and management team were well respected. People, their relatives and staff all felt confident raising concerns and ideas. All feedback was used to continuously improve the service.

For more details please see the full report either below or on the CQC website at www.cqc.org.uk

Rating at last inspection: Requires improvement (Published 17 January 2018). The service remains rated requires improvement. This is the second time the service has been rated requires improvement. We will maintain contact with the provider until the next inspection to understand the action they are taking to improve the rating to at least good.

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

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

This comprehensive inspection was carried out on 2, 3 and 19 October 2017. The first day of the inspection was unannounced.

The Mayfair Residential Care Home Ltd is registered to provide residential care to up to 19 older people including people who are living with dementia. Residential accommodation is provided in an adapted building over five floors. A passenger lift is available. On the dates of our inspection there were 16 people who used the service.

At the last inspection, on 1 December 2015 the service was good. We made a recommendation in relation to one record which did not clearly show the service understood the reasons why a person was being lawfully deprived of their liberty.

At this inspection the service had a registered manager in place. 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 assessment monitoring and mitigation of risk towards people with regard to their support needs, the environment, medicines, and emergency planning was not robust. This meant people’s health and safety was at potential risk of harm.

Care files were inconsistent, with some documentation left blank or not updated in a timely way.

Effective management systems were not in place to safeguard and promote people’s welfare. There was a lack of robust audits and limited evidence of appropriate action being taken to improve the service.

Despite a previous recommendation the provider did not consistently apply the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We identified one person's mental capacity had not been assessed to determine whether an application was required to deprive the person of their liberty.

We made a recommendation that the provider develop their knowledge and understanding of the MCA and DoLS.

Staff showed a good understanding of the processes required to safeguard adults who may be vulnerable from abuse and they were able to explain to us what they would do if they had concerns.

People provided positive feedback about the food. The provider ensured people attended appointments with external healthcare professionals and appropriately sought advice and guidance to meet people's medical needs.

Robust recruitment practices were in place to ensure only suitable people were employed. We observed sufficient staff were deployed throughout the service to meet people's needs. Staff were well trained and received regular updates to enable them to develop their skills. Staff told us the manager was approachable and supportive.

People said staff were kind and caring. Staff had positive and meaningful relationships with the people they supported and they provided support in a compassionate and empathetic way. We observed people were happy, relaxed and content living at the service. People were supported to engage in a wide range of activities of their choosing and to access their wider community to enable them to have opportunities for social interaction and minimise risks of potential social isolation.

People we spoke with were complimentary about the management and staff of the organisation. We found no evidence of complaints being made to the service. People told us they could speak with the provider if they were unhappy about any aspect of their care and support.

We found the provider was in breach of three regulations relating to good governance, safe care and treatment and person-centred care. You can see what action we have told the provider to take at the back of the full version of the report.

This inspection took place on 1 December 2015 and was unannounced. At the last inspection on 7 May 2015 we found the service was meeting the regulations we inspected.

Mayfair Residential Care Home Ltd provides residential care for up to 19 older people. On the day of the inspection there were 18 people living in the home. The service is located on the south side of Scarborough with pleasant views overlooking the South Bay. The service does not offer nursing care.

The home has a registered manager in place. 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.

Staff were able to tell us what they would do to ensure people were safe and people told us they felt safe at the home. The home has sufficient suitable staff to care for people safely, they received regular supervision and they were safely recruited. People were protected because staff handled medicines safely. The home minimised the risk of cross infection because staff were training in infection control and knew how to care for people according to the service’s policy and procedure.

Staff had received training to ensure that people received care appropriate for their needs. Staff were able to tell us about effective care practice and people had access to the health care professional support they needed.

Staff had received up to date training in Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff ensured that people were supported to make decisions about their care, people were cared for in line with current legislation and they were consulted about choices. We made a recommendation in relation to one record which did not clearly show that the service understood the reasons why a person was being lawfully deprived of their liberty.

People’s needs in relation to food and drink were met. People enjoyed the meals and their suggestions had been incorporated into menus. We observed that the dining experience was pleasant and that people had choice and variety in their diet.

People were treated with kindness and compassion, though occasionally we noted that staff spoke to people in a rather directive manner. However, we saw staff had a good rapport with people whilst treating them with dignity and respect. Staff had a good knowledge and understanding of people’s needs and worked together as a team. Care plans provided information about people’s individual needs and preferences.

People enjoyed the different activities available and we saw people smiling and chatting with staff. Staff made daily records of people’s changing needs. Needs were regularly monitored through daily staff updates and regular meetings.

People told us their complaints were handled quickly and courteously.

The registered manager was visible working with the team, monitoring and supporting the staff to ensure people received the care and support they needed. People told us they liked the registered manager and that they were approachable and listened to them.

The registered manager and staff told us that quality assurance systems were used to make improvements to the service. We sampled a range of safety audits and care plan audits which were used to plan improvements to the service.

We carried out an unannounced comprehensive inspection of this service on 22 October 2014 and found a breach of legal requirements. Staff had not always acted in a timely manner when there were risks to people’s health and there was not an effective quality assurance system in place which could identify risks to people’s health and wellbeing.

Following the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook an unannounced focused inspection on the 7 May 2015 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Mayfair Residential Nursing Home on our website at www.cqc.org.uk’

Mayfair Residential Care Home provides accommodation and personal care for up to 19 people. On the day of our inspection the service was providing support for 16 older people. Four of those people were living with dementia. The service is a Victorian House situated on the Esplanade in Scarborough which is close to bus routes and local amenities as well as the cliff lift which takes people to the beach.

There was a registered manager at this service. 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 and associated Regulations about how the service is run.

We found at this inspection that care planning had improved and risks to people’s health were being assessed properly. The service had purchased a new system for the management and quality assurance of the service which was being put in place. This included tools and guidance around care planning and risk assessment. The service had started to reassess people’s needs and put new care plans and risk assessments in place.

Because the system was not yet fully operational we found that the quality assurance systems were not fully utilised which meant that although improvements were being made the service still had work to do to ensure that the quality of the service continued to improve.

We have recommended that the service look at good practice guidance around care planning and risk assessment in order to continue their improvements.

We have recommended that the service continue to follow good practice guidance around quality assuring a care home.

We inspected the home on the 22 October 2014, from 8.50am until 4.45pm, the visit was unannounced. Our last inspection took place in July 2013 and at that time we found the service was meeting the regulations.

Mayfair Residential Care Home Limited is registered to provide accommodation for up to 19 people who require personal care. The home does not provide nursing care. Care is provided on three floors in singly occupied rooms and these are linked by a passenger lift or short flight of stairs. There are communal areas for dining and relaxation. On street car parking is available. On the day of our inspection 17 people were living in the home.

During this visit, we spoke with ten people living at the home, one visitor, three members of staff, the registered manager and the provider.

The home had a registered manager who had been registered since June 2013. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

Some people living in the home had complex needs and had difficulties with verbal communication. The staff had developed different communication methods in accordance with people’s needs and preferences. This approach reduced people’s levels of anxiety and stress.

People told us they felt safe in the home and had good relationships with the staff team.

The home had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The manager had been trained to understand when an application should be made, and in how to submit one. This meant that processes were in place to help ensure people were safeguarded.

We found people were cared for, or supported by, sufficient numbers of suitably qualified, skilled and experienced staff. Staff had good relationships with the people living at the home and the atmosphere was happy and relaxed.

We saw that overall people were supported well and in line with their individual care needs and that staff provided the level of support required. It was clear to us that the staff knew people well and demonstrated a good level of care. However, we noted that care plans did not always fully reflect the level of support people were receiving, how needs should be met and for two people action had not been taken to address aspects of care which could impact on the persons welfare. For this reason we have asked the registered person to take steps to make sure people are protected against the risks of receiving care or treatment that is inappropriate or unsafe.

We observed interactions between staff and people living in the home and staff were kind and respectful to people when they were supporting them. Staff were aware of the values of the service and knew how to respect people’s privacy and dignity.

Suitable arrangements were in place to make sure people were provided with a choice of suitable healthy food and drink ensuring their nutritional needs were met.

People were able to choose where they spent their time for example in a quiet lounge, outside or in a busier lounge area. However, some people told us they were ‘bored’ and that they did not always have access to activities they would like. We saw people were involved and consulted about the service including what improvements they would like to see. Staff told us people were encouraged to maintain contact with friends and family.

People we spoke with did not raise any complaints or concerns about living at the home, but knew who to speak to if they were unhappy.

There was no schedule of auditing significant areas which impacted on people’s care and wellbeing such as the environment and infection control, care plans and medication. This meant that issues around safety and health were not being identified and followed up as a way to improve the service for people. For example, we found shortfalls in the recording of care, action being taken to address health related matters and no evidence that the quality or standard of cleaning in the home was being monitored. For this reason we have asked the registered person to take steps to make sure people are protected from the potential risk of harm because of the lack of an effective system to regularly assess and monitor the quality of the services provided. And to make sure people are protected from the potential risk of harm because there was no effective system in place to identify, assess and manage risks relating to the health, welfare and safety.

We spoke with two people who lived at the service and looked at ten completed survey forms which had been distributed by the home. People told us they were satisfied with their care. One person told us "The staff will always help you if they can. We go out for a walk and for a drink at the local. I can go shopping for the things I need with them too".

People's care needs were assessed and care plans were drawn up which staff read and understood. Risks were considered to ensure people were protected from harm. Specialists were consulted to ensure people had the benefit of expert advice. Staff told us they communicated about people's care needs in meetings and at handover times between shifts.

People's capacity to consent to care and treatment was assessed and measures were in place to ensure people were not unlawfully deprived of their liberty.

Staff were suitably checked to ensure they were safe to work with vulnerable people. They had received training in safeguarding of adults and abuse awareness so that they knew who to refer to should they suspect abuse.

There were sufficient staff on duty at all times to ensure that people received the care they needed.

The home had systems in place to monitor and evaluate the quality of care so that the standard of service could improve.