The inspection took place on 13 and 19 December 2018 and was unannounced. Our last inspection was in June 2018 where we rated the service ‘Inadequate’ and placed it in ‘special measures’. We identified five breaches of the legal requirements in relation to consent, risk management, infection control, medicines, person-centred care, dignity and governance. This inspection found continued concerns in these areas and three additional breaches of the legal requirements in relation to recruitment checks, maintenance and notifications to CQC.

Following the last inspection, we met with the provider and asked the provider to complete an action plan to show what they would do and by when to improve all five key questions to at least good. There had been ongoing meetings with the local authority and the provider submitted weekly action plans to CQC. Our findings at this inspection showed that whilst action had been taken to address individual issues, there were continued breaches of the legal requirements of the regulations.

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.

Mayfield House accommodates up to 34 people in one adapted building. The service supports older people who have physical conditions and require support with mobility. The majority of people at the home were living with dementia. At the time of our visit, there were 19 people living at the service.

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 were not always protected from avoidable harm because known risks had not always been assessed and the plans to reduce risk were not always implemented robustly. The home environment lacked cleanliness and people’s rooms and equipment were not always in a safe condition. We had urgent concerns with some maintenance issues with the home environment and asked the provider to take immediate action to keep people safe, these urgent concerns had been addressed by the second day of our inspection.

People’s medicines were managed safely but there was a lack of information about ‘as required’ medicines in people’s records. People’s healthcare needs had not always been met. We found continued shortfalls in how people’s healthcare appointments were tracked and found instances where changes to people’s health had not been responded to robustly.

People’s legal rights were not protected because staff did not always follow the process outlined in the Mental Capacity Act 2005 (MCA). Restrictions had been placed on people without consent and the registered manager lacked understanding of how to apply the MCA. Best practice had not always been followed for people living with dementia and the home environment was not always suited to people’s needs. Staff lacked knowledge and understanding and systems to track training were not in place. We received negative feedback about the food and staff did not always have the right training to meet people’s nutritional needs.

People did not always receive dignified care because they lived in an unclean and malodourous environment. We identified instances where people’s personal hygiene needs had not been met which impacted on their dignity. People told us that staff regularly entered their rooms without knocking and there was a lack of involvement of people in their care.

There was a continued lack of opportunities for people to go out in the community and people told us they felt bored by the activities on offer. Care plans were not personalised and were writte

The inspection took place on 18 June 2018 and was unannounced. Our last inspection was in June 2017 where we identified one breach of the legal requirements relating to consent. We also identified shortfalls in record keeping and risk management. At this inspection, we identified a continued breach of the legal requirements in relation to consent, as well as four further breaches in relation to risk, infection control, medicines, person centred care, dignity, complaints and governance.

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.

Mayfield House accommodates up to 34 people in one adapted building. The service supports older people who have physical conditions and require support with mobility. The majority of people at the home were living with dementia. At the time of our visit, there were 20 people living at the home.

There was not a registered manager in post, the manager of the home was in the process of registering with CQC. 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 provider had failed to sustain improvements at the service. After our last inspection, we noted improvements had been made and the service came out of special measures. However, these improvements had not been embedded and by the time of this inspection there had been two changes in management in the last 12 months. We also found that there was a lack of governance and record keeping at the service. We identified risks to people that had not been assessed and there was no guidance for staff on how to support them safely. Information about people’s needs and what was important to them was inconsistent and inaccurate. There was no analysis of incidents or complaints which showed there was not a proactive approach to identifying and responding to concerns or risks.

Shortfalls in the maintenance of the home environment meant that people were not always protected from the risk of the spread of infection. We identified bathroom and toilet areas in which a lack of repairs meant rooms could not be properly cleaned and equipment was stored within these environments which heightened the risk of it becoming contaminated. The provider’s audits and checks had failed to identify or address these issues. We identified odours in areas of the home that meant people did not always live in a home environment that provided dignity. We also found times where the home environment did not effectively support people living with dementia.

People were not always supported to access healthcare professionals. We identified instances where people had not attended planned appointments and there was no evidence of staff taking action in response to this. We also identified clinical risks not being monitored and a lack of guidance for staff where people were living with diabetes. We identified inaccuracies in medicines recording and management that meant people did not always receive their medicines safely.

People’s consent was not always sought in line with current legislation. Staff did not always correctly follow the Mental Capacity Act 2005 (MCA) when placing restrictions upon people. We observed staff not always being respectful of people’s privacy and people were not always involved in their care. There was a lack of variety of activities and outings for people to take part in. Information on how people could raise a complaint was not accurate and the provider did not have a system to track and monitor verbal complaints. We made a recommendation about complaints.

There were

This inspection took place on 23 June 2017 and was unannounced.

Mayfield House is a residential care home providing support to up to 34 older people. At the time of our inspection there were 14 people living at the home. Some people at the home were living with dementia.

There was not a registered manager in post. A new manager was in the process of registering at the time of our 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.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Although further improvements are required, this service is out of Special Measures. We will continue to monitor and inspect the service for continued improvements.

At our last inspection we found breaches of regulation. At this inspection we found that most improvements had been implemented. However, we did find one continued breach of regulation.

People’s rights were not protected because the provider had not followed the guidance of the Mental Capacity Act (2005). Staff training in this area was not effective as staff were unable to say how the process applied to their work.

Improvements had been made to records but some information around risks to people was not in place at the time of inspection. We recommend that the provider regularly reviews their records, particularly in relation to risk assessments and that these are maintained accurately at all times.

People lived in a clean and safe home environment. The provider had implemented improvements to the home and kept it clean and well maintained. Robust audits had been introduced to ensure the home remained clean and where maintenance work was required, this was actioned by management.

Risks to people were managed safely. Staff took action to reduce risks to people and where appropriate, made referrals to healthcare professionals. The provider was in the process of introducing new risk assessment forms at the time of inspection. Where incidents occurred, plans were put in place to prevent them from happening again.

People’s medicines were managed and administered safely. The provider had introduced new storage and medicine management systems, with regular audits in place. People received their medicines as prescribed and in line with their wishes.

People’s care plans were person centred. Improvements had been made to the information available to staff. People’s preferences and backgrounds were clearly documented. Reviews were carried out to identify changes in people’s needs. Staff knew the people that they supported well. The provider had made improvements to the activities on offer to people. We saw evidence of people participating in activities that they enjoyed and reflected their interests.

People’s dignity was promoted by kind, respectful staff. Staff supported people in a way that promoted their privacy and dignity. People told us that they got along well with the staff. People’s independence was promoted by staff. Staff understood their role in safeguarding people from abuse and demonstrated a good knowledge of local safeguarding procedures.

The quality of people’s care was monitored and where shortfalls were identified, improvements were implemented. People benefitted from regular meetings in which they were consulted on changes at the home.

People’s nutritional needs were met by staff. People were offered choice with food and their dietary requirements we

This inspection was carried out on the 20 December 2016. Mayfield House Residential Home provides accommodation and personal care for up to 34 people. At the time of the inspection there were 24 people living at the service.

We carried out an unannounced comprehensive inspection of this service on 22 August 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. After that inspection we received concerns in relation to people’s safety and the lack of management oversight of the service. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Mayfield House Residential on our website at www.cqc.org.uk”

There was no registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Risks to people where not being managed appropriately. People were not always being moved in a safe way. Incidents and accidents to people were not being managed appropriately. Where a risk had been identified around a person’s behaviour there was not always appropriate guidance in place to reduce the risks.

People were not protected against the risk of abuse. Where safeguarding incidents had been referred to the provider appropriate action had not been taken. Not all safeguarding incidents had been referred to the CQC and the local authority.

Medicines were not managed safely and there was a risk that people did not receive their medicines when they needed. Staff competencies with medicines were not being assessed.

People were not always protected from being cared for by unsuitable staff because robust recruitment was not in place. There were gaps in the recruitment checks and there was not always evidence of why the provider felt that staff were suitable to work at the service.

The provider did not always have systems in place to regularly assess and monitor the quality of the care provided. There was a continued breach from the previous inspection around the competencies of staff and people care plans not being updated that had still not been addressed.

The provider did not have systems in place to regularly assess and monitor the quality of the care provided. There were continued breaches from the previous inspection that had still not been addressed. The provider had not actively sought, encouraged and supported people's involvement to improve the quality of care. People’s records were not always up to date or accurate.

The provider had improved the infection control practices since the last inspection and action had been taken to try to prevent the risks associated when people smoked in a garden area.

There were instances where people were receiving their medicines as prescribed and staff were signing correctly to say the person had taken them. The medicines were stored correctly.

Mayfield House Residential Home is a care home which provides accommodation and personal care for up to 34 people. At the time of our visit there were 25 people living at the home most of who are living with dementia. The accommodation is provided over two floors that are accessible by stairs and a lift.

The inspection of Mayfield House took place on 22 August 2016 and was unannounced. This inspection was to follow up on actions we had asked the provider to take to improve the service people received.

The provider was covering the registered manager’s role at Mayfield House. 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. We were informed following the inspection that the deputy manager had commenced the application process to be registered as manager with the CQC.

At our previous inspection on 13 August and 1 September 2015 we found breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action in relation to infection control, risk management, obtaining consent in accordance with the requirements of the Mental Capacity Act 2005 and assessing and monitoring the quality of the service provided. Where the regulations were not being met, the provider sent us an action plan and provided timescales by which time the regulations would be met.

During this inspection we found that some improvements had been made. However, they were not sufficient enough to meet the requirements of the regulations.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

People were not always safe because there were a number of inconsistencies in the systems and arrangements in place to protect people from harm. Robust and up to date risk assessments were not in place to identify, assess and manage risk safely to minimise the risk of harm to people.

People did not live in a safe well maintained environment. There were a number of concerns in regard to the environment that put people at risk of harm. People were at risk because there were inadequate systems and arrangements to protect people from the spread of infection. Appropriate standards of cleanliness were not being maintained. Infection control policies and procedures were in place; however it was clear staff had not followed these. We raised concerns about the conditions of chairs, commodes and toilet seats. We also raised concerns with the registered provider about the conditions of some of the bathrooms and toilets. All of these concerns placed people at risk of infection and harm.

Although there was a system to manage and report incidents, accidents and safeguarding concerns to monitor people’s safety, we could not access information about any accident or incidents that happened after April 2016. The management team did not monitor trends or identify patterns in regard to accidents or incidents.

People were not always protected from being cared for by unsuitable staff because although recruitment processes in place, they were not always followed. There were insufficient numbers of staff deployed who had the necessary skills and knowledge to meet people’s needs. The deployment of staff had an impact on the care people received.

Staff did not have a clear understanding of their responsibilities regarding the Mental Capacity Act or Deprivation of Liberty Safeguards. Where people lacked capacity they were not fully protected and best practices were not being followed.

There were inconsistencies in the care that people received; this included how staff respected people’s privacy and dignity. During our observations, we saw examples of good and poor care; staff we

We visited Mayfield House Residential Home on 12 November 2013 and raised concerns that people were not protected from risk of infection because appropriate guidance was not followed. People were not cared for in a clean and hygienic environment. People were not cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. During our follow up visit on 27 February 2015, we saw that the provider had made improvements that were required to be compliant with the regulations.

The service has a registered manager who is currently on leave. 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 provider made interim arrangements to ensure continuity of the service during the registered manager’s absence

During the inspection we spoke with people who used the service, a relative and visitors of people who used the service and from staff who worked at the service. We also spoke with a healthcare professional.

We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our review of records, observations during the inspection, speaking with three people, one relative and two visitors of people who used the service, speaking with six staff who supported the people who used the service and a healthcare professional.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

A person who used the service told us, their room was “Nice, clean and fresh.” Another person told us, “I'm very happy here” and showed us their room which was observed to be clean and well maintained. A relative told us, “There has been vastly improved cleaning, now absolutely perfect...best home could wish for.”

Records showed us the provider had cleaning schedules in place carried out by cleaning staff. We also noted kitchen staff carried out deep cleaning tasks on a schedule in addition to daily cleaning. This meant risks associated with an unhygienic environment were minimised for people who used the service.

All the staff we spoke with were knowledgeable about the provider's policy regarding infection control. Records showed us staff signed when they had read the policy. Staff told us how they used personal protective equipment and the importance of hand washing and we observed staff following the policy during the inspection. A healthcare professional told us they found the home “clean and fresh.”

Records showed us the provider’s recruitment policy was followed. We found the provider obtained two references, photographic identity and carried out Disclosure and Barring Service (DBS) checks prior to staff commencing work. This meant people were supported by staff who were of good character and able to work with vulnerable adults. We noted staff received a comprehensive induction when they commenced employment and this meant people were supported by people who were competent.

Is the service effective?

People told us that they could make choices about how they spent their time. Guidelines were provided for staff in the way people preferred their care and support to be delivered. Staff communicated information about people’s needs effectively and provided care and support in a consistent way.

Is the service caring?

One relative told us, “Staff are unbelievably good...extremely conscientious...and do an immaculate job.” A healthcare professional told us, “staff are lovely here, will ring them (community nursing service) if they have any concerns about people.”

Is the service responsive?

We observed staff interacting well with people and promoting their choice of when they received personal care, of ensuring their clothing was clean and presentable. Cleaning staff were noted to be efficient and responsive.

Is the service well-led?

The provider had schedules to monitor cleaning and maintenance work. The provider told us they held regular staff meetings to ensure staff were kept informed about their responsibilities. A maintenance person was employed to provide support to the service on a regular basis. The provider tendered for specialist work, for example, obtaining specialist quotes for a deep clean of the kitchen area in addition to its cleaning schedules. This meant the provider demonstrated some effective quality assurance monitoring. We noted the provider had made improvements to the areas identified in the previous inspection, for example, new flooring and decorating of identified areas. However, the cleaning of the laundry area was still a concern due to impeded access to the back of the operational laundry equipment. The manager told us they would ensure excess items were removed so the cleaning schedule could be carried out.

We visited Mayfield House and looked at the care and welfare of people who used the service. During the inspection we spoke with the manager and three members of staff, nine people who used the service, one relative and a health care professional.

People who used the service knew they had a right to refuse consent to care. A relative told us “They always ask my family member first.” They went onto say “I hear staff asking her permission and giving her choices.”

We found arrangements were in place that ensured people had their nutritional needs met. A person using the service told us “The choice is good” and added “I can have something different if I don’t like what is on the menu.”

We asked people who used the service if the home was kept clean and fresh, seven agreed with this statement, and others added comments such as “As far as I know” and “To the best of my knowledge.” We raised concerns about the conditions of the laundry room, the kitchen, staff toilet facilities, hand basins throughout the home, and mattresses in unoccupied rooms.

We saw that a recruitment process had been followed. This ensured that people’s needs were met by staff who were appropriately qualified and experienced.

All of the people we spoke with were very happy with the service. We saw that the provider had a complaints policy and that information about how to complain was available to people in a format that met their needs.

The healthcare professional we spoke with told us “It is a home from home here.”

We carried out this follow up visit to check on improvements made in relation to quality monitoring at this service.

During this return visit in January 2013 we did not speak with people directly on this matter, though at our previous visit in September 2012 we received a number of very positive comments when we asked about the quality of the service. One resident who had been at the home for some years told us “I would recommend this house to anyone.” Another person who had only moved in the day before the last inspection told us they had been “Very pleasantly surprised.”

During our visit we interviewed three residents in some detail, and spoke with ten others during the lunch period in the dining room. We also interviewed three relatives who were visiting the home and a community physiotherapist.

People were asked if staff were respectful towards residents and without exception, we were assured that residents were treated respectfully.

We were told people got the care they needed, when they needed it, and that staff seemed well trained for the work they were doing. The visitors we spoke to confirmed their relatives were happy at Mayfield House.

People said that the food and activities were “Very good”, and when asked about their overall opinion of the quality of the care they received, we received a number of very positive comments. One resident who had been at the home for some years told us “I would recommend this house to anyone.” Another person who had only moved in the day before this inspection told us they had been “….very pleasantly surprised.”

This was an unannounced inspection that took place on 13 August and 1 September 2015.

Mayfield House is owned by Beaconfield Care Limited and is registered to provide accommodation with care for up to 34 people. At the time of our visit, there were 27 older people living at the home. The majority of the people who live at the home are living with dementia, some have complex needs. The accommodation is provided over two floors that were accessible by stairs and a stair lift.

The provider was covering the manager’s role at Mayfield House. 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 were not always safe because there were a number of inconsistencies in the systems and arrangements in place to protect people from harm. Risk assessments were not place to identify and minimise risk of harm to people living and visiting the home. We raised concerns about the conditions of carpet after a toilet overflowed, infection control and building work being carried out at the home.

The medicines administration records (MAR) were not accurate and contained gaps. People told us that they were happy with the support they received to manage their medicines. We found the medicines were stored securely and in appropriate conditions. Any changes to people’s medicines were verified and prescribed by the person’s GP.

People’s rights were not protected when they were unable to make decisions for themselves. People’s human rights were not protected as restrictions were put in place which were not in accordance with current legislation.

There were quality assurance systems in place, to review and monitor the quality of service provided, however they were not robust or effective at identifying and correcting poor practice.

Those that were able to talk to us, told us they felt safe at the home. The majority of the people living at the home are living with various forms of dementia. Some people were unable to communicate with us verbally, but others told us they felt safe.

People were protected from the risk of abuse because staff knew their roles and responsibilities should they suspect it was taking place. A relative told us, “I feel that mum is very safe here, staff are very caring.” There were systems and processes in place to protect people from abuse and staff had received safeguarding training.

Recruitment practices were safe, were followed and relevant checks had been completed before staff commenced work. People who lived at the home and staff told us that there were enough staff on duty to support people at the times they wanted or needed. The home had a call bell system in place that enabled people who chose to stay in their rooms to call for assistance when needed. However on the day of the inspection, there was a staff shortage and we saw how this affected the care and support provided. We made a recommendation that the provider reviews and includes the layout of the building when deploying staff to meet individual’s care and support needs.

The design and decoration of the home did not meet people’s individual needs and help people find their way independently. We recommended that the provider researches and implements relevant guidance on how to make environments more ‘dementia friendly’.

People were involved in how they were kept safe at the home. People’s risk assessments regarding their behaviour, health and care needs were discussed with them.

The manager ensured staff had the skills and experience which were necessary to carry out their role. We found the staff team were knowledgeable about people’s care needs; however staff’s knowledge and understanding of people living with dementia and visual impairment was not sufficient to support their additional needs. We recommend that the provider reviews current best practices regarding people living with dementia, visual impairment and other complex needs.

People had enough to eat and drink and there were arrangements in place to identify and support people who were nutritionally at risk. Staff provided care and support which promoted well-being. Healthcare professional were involved when assessing health risks. People were supported to have access to healthcare services.

Staff treated people with kindness and respect. Positive caring relationships had been developed between people and staff. Staff showed kindness to people and interacted with them in a positive and proactive way. Staff were caring. People told us that staff treated them with respect and dignity when providing personal care. People felt that staff knew them well. People’s preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people’s wishes. People’s relatives and friends were able to visit.

The activities that were provided were not always what people wanted and were not always age appropriate. There was no physical stimulation for people living with dementia or complex needs. We recommended that the provider reviews activities in accordance with people’s hobbies and interests.

People said that staff were attentive and responsive to people’s needs. People’s needs were assessed when they entered the home and reviewed regularly. Care records were updated by staff involved in their care. People had access to equipment to assist with their care and support to enable them to be independent.

There was no physical stimulation such as interactive tactile activities or textured surfaces around the home for people that would have provided them with something to do during the day when organised activities were not happening. The manager acknowledged that further work was needed to ensure people received stimulation and enjoyable activities. We made a recommendation that the provider researches and implements relevant guidance on how to make activities for people who live with dementia more 'dementia friendly'. 

People told us if they had any issues they would speak to the manager or provider. People were encouraged to voice their concerns or complaints about the service and there were different ways for their voice to be heard.

We found a number of 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 this report.