The inspection took place on 03 July 2017 and was unannounced.

Mayfair Lodge provides personal care for up to 62 older people. The service is not registered to provide nursing care. There were 58 people accommodated at Mayfair Lodge at the time of this inspection.

The home had a registered manager. 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.

When we last inspected the service on 13 July 2015 the service was rated as overall good with one area rated as requiring improvement. At this inspection we found that the registered manager and staff team had made improvements in relation to promoting people’s dignity and respect.

People felt safe living at Mayfair Lodge. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. The home was calm and people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received regular one to one supervision from a member of the management team which made them feel supported and valued. People received the support they needed to eat and drink sufficient quantities to maintain good health. People’s health needs were well catered for with appropriate referrals made to external health professionals when needed.

People and their relatives complimented the staff team for being kind and caring. Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

The provider had arrangements in place to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or management and were satisfied that they would be listened to.

There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the registered manager if they had a concern. The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

The inspection took place on 13 July 2015 and was unannounced.

Mayfair Lodge provides accommodation and personal care for up to 62 older people. The service is not registered to provide nursing care. There were 56 people accommodated at the home at the time of this inspection.

We last inspected the service on 19 August 2013 and found the service was meeting the required standards at that time.

The home had a registered manager. 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.

CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that applications had been made to the local authority in relation to people who lived at Mayfair Lodge and some were pending an outcome.

People felt safe living at Mayfair Lodge. Staff knew how to keep people safe and risks to people’s safety and well-being were identified and managed. The home was calm and people’s needs were met in a timely manner. The manager operated robust recruitment processes which helped to ensure that staff members employed to support people were fit to do so. There were suitable arrangements for the safe storage, management and disposal of people’s medicines, including controlled drugs.

Staff had the skills and knowledge skills necessary to provide people with safe and effective care and support. Staff received regular support from management which made them feel supported and valued.

People were supported to make their own decisions as much as possible. People received support to eat and drink sufficient quantities. People’s health needs were well catered for because appropriate referrals were made to health professionals when needed.

All people we spoke with were complimentary about the care and kindness demonstrated by the staff team. Staff were knowledgeable about individual’s needs and preferences and people were involved in the planning of their care where they were able. Visitors were encouraged at any time of the day and people’s privacy was promoted. We observed sensitive and kind interactions between staff and people who used the service however, we also noted some interactions on one unit in the home which did not promote people’s wellbeing and dignity.

There were arrangements for activities and stimulation in the home, seven days a week. This provision was under development at this time to increase the opportunities for people to become further engaged. There were arrangements in place to facilitate feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or management and satisfied that they would be listened to.

There was an open culture in the home and relatives and staff were comfortable to speak with the manager if they had a concern. The provider had arrangements in place to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

The people who used the service and their relatives told us that the home was much nicer now. It was fresher and cleaner and the staff seemed better able to cope with the people's needs and wishes. At the last inspection we had concerns about how the people were cared for, these included how they were assisted to eat and how fluid was offered to the people. We also found that the people had to wait for over long times for attention. There were no effective systems in place to monitor how the home was meeting the needs of the people. Staff were not empowering people to live their own lives as they wished to. On this visit we found that all the areas we had concerns about had been addressed.

During our visit we were able to gain the views of six people who live at Mayfair Lodge. We received varied comments about the service being provided. Two people told us they were happy with the service and enjoyed their meals. People told us the staff were careful when they gave them their medicines. Two people felt they were not always listened to as comments did not get acted on. One person told us that the staff can appear to be very busy and they had to wait for their call bell to be answered. We spent time with people who were not so able to give us their views and observed that overall staff responded positively to their needs and spent time explaining what was happening and offering reassurance and comfort. In one area, we noted people had not been given access to objects and items that would provide stimulation and points of interest. Not all staff were skilled in talking to people living with dementia without using words that could be misunderstood.

Two relatives told us that staff kept them up to date with any changes. They said that the staff were caring and supportive.

We observed that people were living in a fresh clean environment and had been able to add personal furnishings and possessions to their room to make them their own.

We observed there were safe procedures in place to give people their prescribed medicines.

People with whom we spoke are happy living at the home. They told us that the staff team are good and look after them well. People said they felt they were treated with dignity and respect. One person told us "Everybody knocks before they come into my room." and another person said "They look after me really well."

Relatives of people living in Mayfair Lodge told us they felt that people were safe and that their human rights were protected. One family member with whom we spoke told us "I'm very impressed with the home, everyone has been very helpful with lots of ideas to help our relative to settle in." another person said "From what I have seen the staff team have the skills to care for my relative."

Eleven out of fourteen people, we spoke with, raised concerns about the lack of contact they had with staff during the day and having to wait for attention. People sitting in the lounge areas told us they were anxious about needing to go to the toilet, because staff were not present and they had no means of attracting their attention. One person told us that, “staff say they will be with you in five minutes and come back in an hour”, “they are so busy”. Another person told us they disliked, “all the endless waiting”. Three people we met said that they liked being at Mayfair Lodge and that it “was very good” and they had “no complaints”.

Not everyone received the support they needed to eat and drink and the records used to record and monitor their intake were incomplete.

The quality of care records and staff knowledge about their content was inconsistent across the service. This meant that people were at risk of receiving unsafe care if the staff and care records had not been kept up to date.

We observed that there was a strong odour in some areas of the home, which raised concerns about the management of continence.

People were not being supported by staff who promoted a person centred approach as the care and support we observed was task led and centred on the routines of individual units within the service. Some people reported that staff did not listen and could be, “abrupt” and “irritable”. People felt that there was not enough to do during the day.