Mayflower Care Centre is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Mayflower Care Centre is registered with CQC to provide care for up to 76 older people with nursing needs who are living with dementia. The service provides support to people who are elderly, frail, have palliative care needs and who have complex needs and challenging behaviours. The service is divided into five units. Diamond on the ground floor caters for up to 26 people who are frail. Sapphire and Opal units on the first floor provide care for up to 30 people. On the second floor Amethyst and Emerald units cater for up to 20 people with complex needs including behaviours that challenge themselves or others and mental health problems. There were 69 people living at the service at the time of the inspection.

The service was run by a registered manager who was present on both days of the inspection visit. 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 and 11 July 2017, the service was rated overall as Requires Improvement. We found breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people did not always receive their medicines as prescribed and people’s care records were not always accurate or assessable. The provider sent us an action plan on 11 October 2017 which stated that they would comply with the Health and Social Care Act 2008(Regulated Activities) Regulations 2014 by the end of November 2017.

At this inspection on 19 and 20 July 2018, we found that there had been improvements in the management of medicines and record keeping. Auditing processes were effective in identifying and addressing any medicines shortfalls. Staff continued to be trained and have their competency in giving medicines assessed to make sure people received their medicines as prescribed by their doctor to maintain their health. The electronic care planning system had been embedded. Staff accurately recorded information about people which could be easily accessed to give a clear overview of people’s health and well-being.

People and their family members said people were well cared for and felt safe. Staff knew how to recognise any potential sign of abuse and felt confident to report them to help keep people safe.

To keep people safe, assessments of risks to their safety and welfare had been carried out by registered nurses and action taken to minimise their occurrence. Health and safety checks were effective in ensuring that the environment was safe and that equipment was in good working order. Accidents and incidents were monitored and appropriate action taken in a timely manner to evidence that lessons had been learned.

The provided operated an effective recruitment process. They continued to monitor staffing levels based on people’s assessed needs to make sure there were sufficient staff on duty at all times.

People benefitted from a clean environment and staff knew what to do to minimise the spread of any infection.

People were supported to access health care services when needed. The provider worked in partnership with a range of healthcare professionals to ensure people received appropriate care and treatment. People had sufficient food and drink and were provided with choices at mealtimes.

Registered nurses were employed to provide the professional expertise required to respond to people’s often complex care needs. A staff training and supe

Mayflower Care Centre is a care home providing accommodation, personal and nursing care for up to 76 older people with nursing needs who are living with dementia. The service provides support to people who are elderly, frail, have palliative care needs and who have complex needs and challenging behaviours. The service is divided into five units. Diamond on the ground floor caters for up to 26 people who are frail. Sapphire and Opal units on the first floor provide care for 30 people. On the second floor Amethyst and Emerald units cater for up to 20 people with complex needs including behaviours that challenge themselves or others and mental health problems. There were 74 people living at the service at the time of the inspection.

The new manager was in post and after the inspection was successful in their application to register with the Commission. They were registered as manager of the service on 4 September 2017. 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.

At the last inspection in November 2016, we asked the provider to take action to make improvements to ensure there were sufficient numbers of staff deployed to meet people’s needs. This was a continued breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan in May 2017 which stated that they had complied with all Health and Social Care Act 2008(Regulated Activities) Regulations 2014.

At this inspection on 10 and 11 July 2017, staffing levels had been increased to meet people needs. However, we found shortfalls in the management of medicines and records.

Staff had been trained and assessed as competent to administer medicines and monthly audits had identified and addressed any medicines shortfalls. However, it could not be assured some people had received their medicines as prescribed by their doctor to maintain their health.

The new care planning system could not be accessed by all senior staff in order to effectively monitor people’s health and well-being. Some people’s care and treatment records were not accurate which could result in them receiving inappropriate staff support.

The service had increased staff levels since the last inspection and continued to review if there were sufficient staff on duty at all times.

People and their family members said they were cared for in a safe place. Staff knew how to recognise any potential sign of abuse and report them in order to help keep people safe.

Assessments of risks to people's safety and welfare had been carried out and action taken to minimise their occurrence, to help keep people safe. Health and safety checks were effective in ensuring that the environment was safe and that equipment was in good working order. Accidents and incidents were monitored and action had been taken as appropriate.

A schedule of cleaning was in place to ensure the service was clean and staff knew the practices to follow to minimise the spread of any infection.

People accessed health care services when needed and the service worked in partnership with healthcare professionals to ensure people received appropriate care and treatment. People had sufficient food and drink and enjoyed the meals provided at the service.

Staff received relevant training which enabled them to support people with a range of needs. Staff felt well supported but had not all received regular supervision and training. The service was developing staff to address this shortfall.

Staff sought and received people's consent to the support they provided and in line with the principles of the Mental Capacity Act 2005. CQC is required by law to monitor the operation of the Depriva

This unannounced inspection took place on 10 November 2016. Mayflower Care Home provides accommodation and personal care for up to 76 people. On the day of the inspection, 75 people were using the service.

At our previous inspection of 5, 6 and 9 March 2015 we found the service was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) 2010 relating to staffing levels and management of medicines. We undertook a comprehensive inspection on 10 November 2016 to check that the service now met the legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Mayflower Care Home’ on our website at www.cqc.org.uk.

We found the action taken to address the breaches was not comprehensive. We identified that the provider was not meeting regulatory requirements and remained in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to staffing.

At this inspection, we found people had not always received safe and appropriate care. The registered manager did not always deploy sufficient staff to meet people’s needs safely.

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 told us they were happy at the service. People and their relatives said staff were kind and caring. Staff upheld people’s dignity and respected their privacy and confidentiality. Staff knew people well and understood their communication needs.

Staff knew how to protect people from abuse. The provider used a safe and robust process to recruit suitable staff. People received the support they required with their medicines. Staff managed and administered people’s medicines safely.

Staff identified risks to people’s health and safety and had sufficient information on how to protect them from harm. The registered manager ensured staff followed guidance in place to manage the risks safely.

Staff assessed and reviewed people’s needs regularly. People’s support plans had guidance for staff on how to deliver care. People and their relatives were involved in planning for people’s care. People received care which reflected their preferences and as planned.

Staff sought and received people’s consent to the support they provided. Staff supported people in line with the principles of the Mental Capacity Act 2005. The registered manager ensured decisions were made in people’s ‘best interests’ if they were unable to do so. Staff upheld people’s rights and appropriately supported those whose freedom was authorised to be restricted under the Deprivation of Liberty Safeguards.

People accessed health care services when needed. The service worked in partnership with healthcare professionals to ensure people received appropriate care and treatment.

People had sufficient food and drink and enjoyed the meals provided at the service. Staff made referrals about people’s dietary needs and monitored their food and fluid intake as required. People took part in activities they enjoyed at the service and in the community.

Staff received training and support that enabled them to plan and deliver people’s support safely and competently. Staff had regular supervision. The registered manager took action to address any knowledge gaps.

The registered manager sought people and their relative’s views about the service and used their feedback to make improvements. People knew how to make a complaint. The service had investigated fully and resolved complaints received in line with provider’s procedures.

The quality of the service was subject to regular checks and audits. The registered manager took action to addr

Our visit was unannounced and early in the morning at 7:50 AM and we found the building fresh and clean and saw that people were treated with respect and dignity.

People told us the food was lovely at the home. They said the staff were nice, they liked their rooms, which were warm enough, and the washing facilities in their rooms worked properly.

We observed good practice with staff having time and spending time talking with people or reassuring them, or just simply holding a hand when needed.

We saw good practice because risk assessments for bed rails took into consideration other less restrictive options, like low beds or a mattress on the floor by the bed and staff had been creative in finding other less restrictive solutions.

We found that although staff did offer choices and seek some verbal consent before offering care, the production of consent forms was not consistent and where people did not have capacity there were no legal systems for assessing capacity or obtaining consent to care and restrictions.

We saw that the service provided safe care, through carrying out initial assessments, planning care based on collating the required information and making decisions based on risk assessments. However, people did not always experience care, treatment and support that met their needs and protected their rights because the service did not involve the people who use the service in their care planning and care plans, had not provided people with an accessible person centred care planning tool to facilitate creating a person centred plan, and had not made the care plans available in any other more accessible formats to facilitate access and involvement. For example, large print, tape/CD, read out, pictorially supported or with language translation.

The last inspection report recorded a shortfall under outcome 13 (regulation 22) and set a compliance action. At this inspection we found that the shortfall had been met and the compliance action closed. We therefore found that there were enough skilled and qualified staff to meet people’s needs.

The last inspection report recorded a shortfall under outcome 14 (regulation 23) and set a compliance action. At this inspection we found that the shortfall had been met and the compliance action closed. We therefore found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The last inspection report recorded a shortfall under outcome 18 (regulation 16) and set a compliance action. At this inspection we found that the shortfall had been met and the compliance action closed. We therefore found that people using the service

could be confident that deaths of people who use services are reported to the Care Quality Commission so that, where needed, action can be taken.

This inspection was to follow up on findings from our previous inspection on 23rd October 2013 and to ensure the provider had taken action with regard to the concerns we had raised. This visit was also in response to additional concerns received by us in relation to medicines and staffing levels. Mayflower Care Centre is registered for a maximum of 76 people. There were 63 residents at the time of visit.

People told us their relatives had "settled in very well" and "whenever they have needed help, they have always had the right help". Professionals who visit the home have commented they “have no concerns with care provided” and “generally quite happy with permanent staff, not so with agency”.

We found the provider had taken action to address the identified concerns around management of medicines and records.

Although the majority of people we spoke to said they were happy with the staff at Mayflower we found there were not enough qualified, skilled and experienced staff to safeguard the health, safety and welfare of service users. We also found staff were not receiving appropriate training to enable them to deliver care and treatment to service users safely and to an appropriate standard.

Following our inspection we were told by the provider they had failed to notify the Commission without delay, of all the home's expected deaths.

This inspection was to follow up the findings from our previous inspection of 11 April 2012, to ensure action had been taken by the provider in regard to the concerns that had been highlighted. This visit was also conducted to respond to additional concerns that had been identified in relation to areas such as the management of medicines and record keeping.

We found that the provider had taken action to address the identified concerns around staffing. It was noted that recruitment is still ongoing and the provider is taking appropriate steps to ensure that people are cared for by sufficient numbers of suitably qualified, skilled and experienced staff. Most people we spoke with recognised that the provider had made improvements in response to the concerns raised around staffing levels at our last inspection. Comments included “The staff are very good and work very hard” “Staff do their best; they come when I need them”. A few people we spoke with, including staff, told us that they still felt that more staff were needed at certain times of the day and at weekends to better support people with their care needs.

Although the majority of people we spoke with told us that they were happy with the standards of care and we saw examples of people being safely and appropriately supported; we found that the provider was not consistently maintaining accurate care records in order to protect people against the risks of unsafe or inappropriate care.

Some of the people in the home had complex needs which meant that they were not able to tell us their views. We therefore used the Short Observational Framework for Inspection (SOFI) in two areas of the home. SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us. The findings of our observations are included in this report.

People we spoke with spoke highly of the staff and described them as “Kind” “Hard-working” and “Very good”. People who used this service said there was a good choice of food and plenty to eat.

We also gathered evidence of people’s experiences by reviewing comment cards, complaints log and surveys. We found that people praised the support and care given by staff with comments such as “Staff were always very kind and considerate”; “Staff on duty do their best” and “I am so glad we moved our relative into this home”. However, some comments expressed concern over the numbers and consistency of staff that were on duty in different areas of the home. These comments referenced a particular concern around the staffing levels on the specialist units being able to meet the complex needs of people using the service.

Some people we spoke with told us that there were not always enough staff to attend to their needs. One person told us that they sometimes had to wait to go to the toilet because there were not always enough staff to help them.

This inspection was unannounced and took place over three days on 5, 6 and 9 March 2015.

Mayflower Care Home provides accommodation, nursing and personal care for up to 76 older people. There were 65 people living at the service at the time of our inspection. Some people are unable to move independently, whilst others need support due to illness or other age related conditions. Some people are able to express themselves verbally, whilst others use body language and other types of communication. The service is divided into five units and each one aims to meet people’s specific needs. For example, one unit provides care and treatment for people who needed nursing care and people nearing the end of their lives. Another is designed to support people with complex needs, such as people living with dementia with mental health problems and behaviours that challenge.

The property is purpose built with flat access and adaptations suitable for people with restricted mobility. Each person has their own bedroom with en-suite facilities. Accommodation for people is over three floors accessed by passenger lifts.

When we last inspected the service on 5 February 2014, we found that the service was not meeting the Health and Social Care Act (Regulated Activities) Regulations 2010. People’s consent and their lack of capacity to consent to care and treatment was not recorded. Care plans did not contain guidance for staff about how people preferred to receive their care. At this inspection we found that breaches from the last inspection had been addressed.

There was a registered manager in post. 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.

At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

People’s welfare was not always safeguarded by sufficient numbers of suitably qualified, skilled and experienced staff. The number of staff on duty and/or their deployment within the service did not always meet all the needs of all people in a timely manner. The shortfall in permanent staff affected the delivery of care for some people.

People were not always protected against the risks associated with the unsafe use and management of medicines. Safe medicine administration procedures were not always followed and could put people at risk.

The areas which accommodated people living with dementia contained some notices to help orientate people. However, the environment was not specifically designed to aid orientation for people living with dementia. We have made a recommendation about this.

There were activities organised in which people could participate. However, these were not always sufficient or specific enough to meet people’s differing needs or preferences and prevent social isolation. We have made a recommendation about this.

Staff knew the correct procedures to follow. However, policies and procedures did not provide staff with written up to date best practice guidelines, including any changes in legislation. We have made a recommendation about this.

The registered manager had a good understanding of how to work with, and follow advice from the local safeguarding authority to protect people. Staff identified and managed risks to people’s safety. People lived in a clean environment. Staff had a good understanding of infection control practice and took measures to ensure that the service was clean and free from the risk of infection. The provider ensured that the premises were maintained safely and securely.

The service operated safe recruitment procedures which made sure staff employed were suitable to work with people. Staff had the appropriate skills and experience to meet people’s needs. They were able to put this into practice by using the knowledge they had gained from training. Staff were supported to work to expected standards through supervision.

Staff sought people’s consent before they carried out any care tasks. Where people lacked the mental capacity to make decisions the service was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests. The system for monitoring Deprivation of Liberty Safeguards (DoLS) within the service protected people from harm and protected their rights.

People were supported to have a choice of food and drink and could choose where they had their meals. Staff took action to reduce the risk to people from poor nutrition and dehydration. People were supported to manage their health care needs and had access to health care professionals, such as a G.P. They were referred to specialists or for hospital treatment where necessary.

People told us they liked their bedrooms and the environment in which they lived. There were various communal areas where people could spend their time.

Staff treated people with kindness. People were supported with their preferences and involved in their care planning in their day-to-day lives. Staff demonstrated respect for people’s dignity and were careful to protect people’s privacy. Staff promoted people’s independence. Specialist care was provided for people who were nearing the end of their lives.

People who were considering moving into the service were assessed to determine if the service could meet their needs. People’s care was personal to the individual and care plans provided guidance for staff about people’s preferences and how they wanted their care to be delivered.

Staff communicated effectively with people, responded to their requests and offered people choices.

The provider had a clear set of vision and values. The service had a clear, accountable management and staffing structure. The service had a welcoming, pleasant and busy atmosphere. People, staff and their relatives thought the registered manager was approachable.

People, their relatives, members of staff and professionals associated with people’s care were asked for their views about how the service was run. These were acted on to improve the service provided. The manager investigated and responded to people’s complaints and concerns. There were regular audits to review the quality of care and safety of the premises.