Mayfield Adult Services provides personal care, support and accommodation to up to four people with a learning disability and personal care to people who live in the community. This unannounced inspection took place on 28 October 2016. At the time of the inspection three people were living at the service and five people received support in the community.

We last inspected Mayfield Adult Services in June 2014. The service met all the regulations we checked at that time.

The service had a registered manager. 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 the service was exceptionally well led and was very responsive to individual people’s needs, wishes and preferences. All people, relatives, healthcare professionals and staff we spoke with were highly positive about Mayfield Adult Services and its management and staff. The registered manager encouraged people to aspire and achieve their goals.

Staff involved people in designing their care plans. Care plans were personalised. Staff looked at people’s progress towards meeting their goals at regular key working meetings. People and their relatives said the quality of care at the service had significantly improved people’s health and well- being. Staff supported people through positive behavioural support which contributed to them experiencing fewer incidents of behaviour which challenged the service.

People accessed healthcare services, specialist advice and treatment when needed and had regular reviews of their health. There was very good communication between the service and health care providers in monitoring and responding to people’s health conditions. This led to fewer avoidable hospital admissions and an improvement in people’s health.

People were safe at the service. Staff understood their responsibility and followed safeguarding procedures to report any concerns to protect people from harm. Staff felt confident to raise any concerns and felt that they would be dealt with promptly.

Risk assessments were centred on the needs of the individual. People and their relatives worked in collaboration with staff and healthcare professionals to identify and assess risks to people’s health and safety. Staff managed risks to people appropriately without restricting their freedom.

Staff were competent to manage and administer people’s medicines safely. Medicines were stored, recorded and disposed of safely and accurately.

The service empowered and gave people choice about their care. People received appropriate support to make decisions about their care in line with the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People took part in activities they enjoyed and received support to pursue their goals. People were supported to develop their daily living skills and to live an active life. There were positive and friendly interactions between staff and people. People were treated with dignity and respect.

People had sufficient food to eat and drink. Staff encouraged people to eat healthily and helped them plan and prepare meals. People received specialist advice about nutrition from healthcare professionals and staff supported them to follow the guidance.

The registered manager encouraged learning for people, their relatives and staff about health conditions which enabled them to respond effectively to people’s needs. Staff received relevant and specialist training on the care of people with autism and attended refresher courses when due.

Staff received regular supervision and appraisal to monitor their performance and professional development. The registered manager was available to people and their relatives.

People at the home had complex needs and were not all able to tell us about their experiences at the home. In order to get a better understanding we observed care practices, looked at records and spoke with staff. During the inspection we spoke with the manager, safeguarding officer and four members of care staff.

At the time of the inspection there were three people who lived at the service and two people who were supported with personal care who lived in the community in supported living accommodation.

Our inspection team was made up of one adult social care inspector. We answered our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff were trained in safeguarding adults and told us they felt confident about the action they needed to take if they had any concerns. There were comprehensive policies and procedures in place to safeguard people that used the service. We found that people were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Care and support was planned and delivered in a way that was intended to ensure people’s safety and welfare. Risks to people who used the service had been identified and there was detailed information on how to manage and minimise them. Staff had been trained to support people in managing challenging behaviour.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Staff had been trained to understand when an application should be made, and how to submit one. We found that the staff understood the requirements of the Mental Capacity Act 2005 and carried out decision specific mental capacity assessments and best interest meetings when needed.

Is the service effective?

It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. Staff had received the training they needed to meet the needs of the people receiving care. Staff had regular opportunities to discuss work related issues and to express their views. The staff we spoke with said they were supported in their professional development. One staff member said "I think it's one of the nicest places I've been to".

Is the service caring?

People were supported by committed and caring staff. We observed that people appeared comfortable in the home and familiar with the staff that worked there. We saw that staff members spoke directly with people and supported them at an appropriate pace. Staff made good use of alternative forms of communication to support people in their involvement in the service and to encourage choice. People were treated with respect and dignity.

Is the service responsive?

People’s needs were continually assessed and reviewed. Records confirmed people’s preferences, interests, goals and diverse needs had been recorded and support had been provided in accordance with people’s wishes. People had regular review meetings with their keyworker to make sure that changes in needs were identified and action taken. Support was person centred and people's wellbeing and development was central to the ethos of the service.

Is the service well-led?

The manager of the service demonstrated a commitment to providing a service which was continuously improving and focussed on the people who used the service. There were a range of quality assurance processes in place to maintain standards in the service and make improvements where these were identified. We saw that staff and people who used the service were given opportunities to express their views and that these were acted on. Complaints were investigated and appropriate action taken to resolve them.