About the service:

•Mayfair Residential Home is a care home registered to provide personal care and accommodation to up to 16 people. The home specialises in the care of people who have mental health needs. At the time of the inspection 13 people lived at Mayfair Residential Home.

People’s experience of using this service:

•Some staff had not been provided with safeguarding training and risks to people had not always been assessed, monitored or reviewed. Where risks to people were identified, detailed management plans were not always in place and people were not always protected from environmental risks. The provider did not keep any records of legionella testing in the home even though there were several unused water outlets.

•Safe practice was not followed to ensure people’s medicines were safely administered. The provider did not have a competency assessment process to determine if staff were competent to administer medicine safely. Staff told us they did an on-line training module and that was not refreshed once completed.

•The home was not clean or well maintained. Toilet seats were broken and coated in faeces. People did not have working showers in their rooms. People told us, “No, it’s (the home) not cleaned enough. I can’t remember when they cleaned my room”.

•There were not enough staff to meet the needs of the people living at Mayfair Residential Home. Recruitment processes did not minimise the risk of employing unsuitable staff.

•Staff did not have a clear understanding of the Mental Capacity Act, (MCA). The provider had not completed specific capacity assessments for people.

•People were not always fully involved in their care and support. Care plans were not person-centred and lacked information about people’s needs, wishes and preferences and confidential information was not stored securely.

•The provider had not ensured there was an effective management structure in place to monitor the care provided. They had also failed to ensure staff were given the support they required to provide safe, effective, responsive care.

•We saw some positive interactions during the inspection, with most staff being kind and friendly when supporting people.

•The provider was trying to make improvements with limited resources available. Following the inspection, the provider sent us an action plan of how the planned to improve the service.

More information about the detailed findings can be found below.

Rating at last inspection:

•At the last inspection the service was rated as Requires Improvement (May 2018). At this inspection we found the service had deteriorated in several areas. The home has therefore been rated as inadequate overall.

Why we inspected:

•This inspection was a scheduled inspection based on the previous rating and aimed to follow up on concerns we found in May 2018.

Enforcement

•During the inspection we identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were at risk from harm because the provider’s actions did not sufficiently address the ongoing failings.

•Full information about CQCs regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

•Ensure that the provider found to be providing inadequate care, significantly improves.

•Provide a framework within which we use our enforcement powers in response to inadequate care, and work with, or signpost to, other organisations in the system to ensure improvements are made.

•Provide a clear timeframe within which the provider must improve the quality of care they provide, or we will seek to take further action, for example cancel their registration.

•If the provider does not demonstrate eno

This inspection took place on 5 April 2018 and was unannounced.

Mayfair Residential home 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.

The Mayfair Residential Home is registered to accommodate up to 16 people. The home specialises in the care of people who have mental health needs. The home does not provide nursing care. At the time of the inspection there were 14 people living at the home.

At the last inspection of the home in May 2016 the service was rated Good. At this inspection we found that improvements were needed in a number of areas. The home has therefore been given an overall rating of Requires Improvement.

The provider is the registered manager for the home. 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.

During this inspection we found that people did not always receive safe care. Risk assessments regarding fire safety and people’s individual care were not always up to date. Care plans were not comprehensive meaning staff did not have all the information they required to effectively support people and to ensure risks were minimised.

Although the provider had some systems to assess and monitor the service these had not been effective in ensuring people received a consistently good standard of care and support. The provider had taken action to address issues raised by outside professionals, but their internal monitoring had not identified the shortfalls. Some repair and refurbishment to the building had not been identified and rectified in a timely manner to maintain people’s safety and comfort. Staff had not received up to date training which would help to make sure the care provided was in accordance with up to date best practice guidance and legislation.

Although the majority of people were able to occupy themselves, there were limited opportunities for meaningful occupation for people who required staff support in this area. One person told us, “It would be nice if they could organise some trips, especially when the weather is nice.”

The provider was working in partnership with other professionals to ensure improvements were made at the home. Full reviews of people’s care and support needs had been carried out. New care and support plans and risk assessments were being put in place to make sure people’s up to date needs were met.

People told us they were happy at the home and felt safe. One person told us, “I feel safe. The staff look after me.” Another person said, “I can’t cope with things but I feel safe here.”

The provider had systems to minimise the risk of abuse to people. These included a robust recruitment process and training for staff. People told us they would be comfortable to talk with staff about any worries regarding their health or their care.

People we spoke with said they were happy with the meals provided and there was always a choice of food. People were able to make hot and cold drinks throughout the day.

People were cared for by staff who treated them as individuals and respected their lifestyle choices. People were able to follow their own daily routines and staff were available when people requested support.

People were fully involved in all decisions about their care and support and were able to refuse support if they chose to. Where people lacked the mental capacity to make certain decisions the staff acted in their best interests in consultation with other professionals.

People who felt confident to access community facilities without staff support were able to do so. One person said, “I’m f

This inspection was unannounced and took place on 24 May 2016.

The Mayfair Residential Home is registered to provide care and accommodation to up to 16 people. The home specialises in providing care and support to people with long term mental health needs. At the time of this inspection there were 13 people using the service.

The provider is also registered to manage the home. 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 last inspection of the home was carried out in January 2015.At that inspection the service was rated as Requires Improvement. We found that improvements were needed to ensure there were adequate risk assessments in place to keep people safe. We also found that quality assurance systems were not effective in highlighting shortfalls and planning improvements.

At this inspection we found that improvements had been made. There were up to date risk assessments to reduce risks to people using the service and others. Improvements had also been made to make sure the quality assurance system identified shortfalls and enabled ongoing improvements to be planned.

The provider took overall responsibility for the management of the home and was supported by a care manager who carried out the day to day management. People and staff described the management as open and approachable.

People were cared for by staff who had the skills and knowledge to meet their needs and interacted with people in a patient and kind way. People felt safe at the home and with the staff who supported them. One person told us “I’m safe here.” Another person said “The staff are always kind to me.”

Staff had a good knowledge of each person and were able to monitor their mental and physical health. They worked with healthcare professionals to make sure people received the care and treatment they needed to meet their healthcare needs.

People’s medicines were safely administered by staff who had received specific training and supervision to carry out the task. People told us they received the correct medicines at the right time. One person said “I always check I have the right tablets. They always get it right.”

People continued to make choices about their day to day lives and were able to follow their chosen lifestyles. Care was planned and delivered in a way that met people’s needs and respected their wishes. People were fully involved in all decisions about their care.

There was a stable staff team which provided a consistent approach to people. It also enabled people to build relationships with the staff who supported them. Staff spent a lot of time chatting and socialising with people. We heard staff laughing and joking with people and there was lots of friendly banter which created a happy atmosphere. One person said “It’s nice to have a laugh.”

There were formal and informal ways for people to share their views, make suggestions or make a complaint. People felt comfortable to speak with the management or staff about any worries or concerns. One person told us “They listen to you and apologise when they get things wrong.”

This inspection was unannounced and took place on 7 January 2015.

Mayfair Residential Home provides care and accommodation for up to 16 people. The home specialises in the care of people who have long term mental health needs.

There is 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. At Mayfair Residential Home the registered manager and provider is the same person. There is a care manager who oversees the day to day running of the home.

The care manager told us the ethos of the home was “For people to do what they want and understand that they don’t have to please us. We provide a safety net and a home but people are part of the local community.” We were able to confirm these values had been put into practice by the comments we received from people. One person told us “This is my home. I go out when I want but I know I can come back here and be accepted for who I am.” Another person said “I pretty much do what I like but there’s always someone to help me when I need it.” One member of staff told us “It’s all pretty laid back. The real ethos is; it’s people’s home and they are the ones who decide what they do.”

There were some systems in place to monitor the quality of care and plan improvements. However these were not always recorded, meaning there was no clear rationale for how improvements were made.

People said they felt safe at the home and were comfortable with the staff who supported them. One person commented “I’m very content here the staff are always good to you. It’s a safe place to live.” Throughout our visit people looked very comfortable with staff and there was lots of chatter and friendly banter.

Care plans contained risk assessments which gave information about the risks people had decided they wished to take. However we saw that although people had signed to state they understood the risks involved in particular activities, assessments were not always comprehensive.

There were sufficient numbers of staff employed to make sure people were supported in an unhurried manner and had opportunities to take part in activities of their choosing. People received effective care and support from staff who had the skills and knowledge to meet their needs. All staff completed an induction when they began work to make sure they had the basic skills to support people. There was ongoing training in health and safety issues and training specific to the needs of people who used the service.

People were very complimentary about the staff who supported them. Comments included “Staff are really good,” “Staff are always kind and friendly” and “I feel it’s my home, they always have time for everyone.” Throughout the day we saw staff spent time talking and listening to people. The atmosphere was very warm and friendly.

People had built relationships with other people they lived with. One person told us “I’ve made friends here. I went with X to get my flu jab. We go out together all the time and spend time in each other’s rooms when we’re at home.” Another person told us “I usually go out with X in the afternoons. It’s really nice to have company.”

There was clear information about the support people required to address their needs and to keep them well. This included signs and symptoms that may suggest a person was becoming mentally unwell, and how to respond to individual situations. The staff worked in partnership with other professionals to make sure people received support and treatment which was responsive to their needs. A psychiatrist and community mental health nurses visited the home regularly which gave people an opportunity to discuss any mental health issues they had.

People continued to make choices about their day to day lives and access community facilities. People chose what time they got up and how they spent their day. We saw some people chose to socialise and others preferred their own company. Each person’s individual wish was respected by staff.

We visited the home and met and spoke with seven people who used the service. We spoke with five staff. We looked at two care records, the recruitment and employment records for one new member of staff and documents relating to the administration and management of the service.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People told us they were very happy living in the home. We also had several ‘thumbs up’ from some of the residents when we asked what it was like to live there. We were told by one person, “They give me all the help that I need.” Another person told us staff talked with them about their care and what they wanted.

People were provided with appropriate food and drink that met their needs and preferences. People who lived in the home told us that they enjoyed the food provided to them. We were told, “We can have what we like and we don’t have to have what is there if we do not want to.”

We saw there was a rolling programme of refurbishment and renewal to improve the quality of life for people living in the home.

People were protected by the safe staff recruitment practices carried out by the provider.

People told us they had very positive experiences with the staff working in the home. One person told us about how pleased they were with the manager of the home and said, “They understand what I need and put things in place to help me.”

This inspection was carried out to check compliance because of two areas identified as for improvement were found at the last inspection visit in July 2011. One improvement action was made in regard to the outcome cleanliness and infection control the other was in regard to the safety and suitability of the premises. We found that both areas were compliant but we suggested the provider to note that there were still areas to develop to improve the outcomes for people living in the home.

We spoke with nine people living in the home and the three staff on duty. The care manager who was not on duty at the time returned to the home to assist with the inspection process. We looked at records relating to the provision of care and support for three people and those for the administration and management of the home.

The people we spoke with said that they felt supported and cared for. They told us that staff helped them with their daily decisions but also encouraged them to be as independent as possible. We were told about how staff supported them to be part of the community such as dining out, participating in local events and socialising. We saw that people had very good relationships with the staff in the home. We found that staff spoke to them respectfully and listened to them. People told us that the felt safe living in the home and they had “no worries.”

The home is set in the town centre of Minehead. People said that they liked the position of the home as it enabled them to easily access local amenities. Throughout the visit we saw that people were able to walk out to local shops and cafes. One person said that they are able to walk to church without staff supervision and another person told us that they often went to the café at the local park.

People asked were generally happy with the care which they received. Comments included “I feel well looked after,” and “They take care of you.” One person said that they had been to view the home before deciding to have a trial stay. This enabled them to see if it was the right place for them at the present time.

Throughout our visit we observed that people were able to make choices about their day to day lives. We noted that people were able to decide what time they got up, what they had for breakfast and how they spent their day. One person said “I do what I like” and another person said “It’s all very free and easy.”

People spoken with were aware that they had the right to refuse any support or intervention. One person, who is at risk of falls, said that they continue to go out without staff supervision. They said “It’s my choice and I know I might fall over but it’s a risk I take.” This decision was recorded in the persons’ care plan.

People living at the home said that the food was usually good and that portions were ample. The main meal of the day is at mid day and people said that there was always a choice. There is no set time for breakfast and we observed that people were able to eat when they got up. One person said “You can eat meals when and where you like.”

People said that the staff who supported them were always kind and polite. One person said “Staff are all very efficient, they seem to like their job and are always cheerful.” Everyone asked knew how to make a complaint and all said that they would be comfortable to do so.

There were positive comments about the staff working at the home these included “They are always kind” and “All very good at their job.” Everyone asked said that the care manager was always available and they could discuss any issues with them.