Our inspection took place on 20th and 21st October 2016 and was unannounced.

Mayfield house is registered to provide accommodation for a maximum of 51 people who may be living with dementia and require assistance with personal care. The two storey purpose built building is situated in a residential area of Crewe in Cheshire. Staff are on duty 24 hours a day to provide care and support for people who use the service.

At the time of the inspection a registered manager was in place. 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 complimentary about the support they received at Mayfield House. The registered manager was available throughout the inspection and engaged positively with the inspection process. The registered manager was friendly and approachable, she operated an open door policy for people using the service, staff and visitors

Staff had received training in safeguarding and understood their responsibilities to protect people from harm and abuse. Staff knew how to report concerns and told us that they felt able to raise concerns appropriately. People felt safe and told us that they received the support that they needed, in a way that respected their wishes. We found that there were sufficient staff, who ensured that they supported people in a thorough and unrushed way. We noted that some areas of the home would benefit from re decoration and some furnishings were in need of replacement.

We found that staff were skilled, knowledgeable and well trained. They received a thorough induction when they began their employment with the home and received on-going training updates. Staff were supported to develop their knowledge and skills.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act were met. People’s nutritional needs were met. We observed that people had plenty to eat and drink and were given appropriate food choices. We saw that staff supported people and understood their nutritional needs. The home had recently made improvements to the quality of the food and meal time experience.

We saw that people were well cared for and very comfortable in the home. The people and relatives who we spoke with were positive about the care they received and told us that the staff were kind and caring. We observed that staff were skilled and patient, treating people with dignity and respect.

All care plans were being re-written due to a new electronic recording system which had been implemented. We found that the focus was on person centred care.

Care records reflected the support that people needed so that staff could understand how to care for the person appropriately. The service was responsive to individual needs. We saw that activities were undertaken on a regular basis, however we found that these could be developed further.

We found that the home was well-led. People knew who the registered manager was and felt able to raise any concerns with her. Staff told us that they felt well supported. We saw that regular team meetings were held, as well as supervision meetings to support staff. A new quality manager role had been implemented and home improvement plan put in place. There were comprehensive quality assurance processes in place and people's feedback was sought about the quality of the care.

We carried out this inspection in reponse to concerns raised by whistle blowers. We were told that there was insufficient staff in the home to meet the needs of the people who lived there. We were also told that the home was dirty, was not cleaned properly and that there was a permanent offensive smell.

We carried out our inspection in the evening so we could speak with day staff and night staff when the shifts changed. We spoke to ten members of staff and they all said that the home was adequately staffed. They all said that the home was kept very clean and they worked as a team to maintain this.

We spoke to eight people who lived in the home. They all had no concerns about staff or the cleanliness in the home. Comments we received included; "The care staff and cleaners all work very hard here, we are very lucky and the home is very clean" and "They keep my bedroom beautiful and they change my bed all the time." In relation to the staff another person said; "There is always someone to help you if you need it. They are patient and don't rush you."

We could not substantiate any of the issues raised by the whistle blowers.

The inspection was unannounced which meant the provider and the staff did not know we were coming. On the day of our inspection we met most of the people living in the home observed how staff supported and cared for people.

We reviewed information about five people’s care and pathway tracked five people using the service. We found that their care needs were assessed and that care was planned. We also found that the staff understood people’s care needs and how to protect them from risk and harm.

We saw that staff respected people’s privacy and dignity, and took account of what people had to say in relation to the way their care was provided. For example, we saw that staff encouraged people to make informed choices about the food they ate and the social activities they participated in each day.

We also saw that people were actively encouraged and given support to maintain their independence.

The staff told us they enjoyed working at the home. We saw that all the required checks were made to ensure they were fit to do their job.

There were systems in place to ensure people could raise concerns and improve the quality of the care received.

We saw information which confirmed complaints were responded to and people were able to voice their opinions.

One visitor said "I think that the home is very good. The staff are respectful and polite. The home is clean and tidy. Mum is safe here”.

The inspection was carried out as part of our routine schedule of planned inspections.

We spoke to three people who live at the home about their experience on being consulted about their care and they informed us that they were always consulted about their care and that "it was all very good". We spoke to two relatives of a person who lived at the home and they told us that they were fully involved with how care and treatment was provided and were happy with the outcome.

We spoke to three people who live in the home and they said that the staff "were always ready to help and the home was lovely". They also told us that they were consulted with the choice of menu and there was always something else if they didn't like it.

Of the three people we spoke to one person said the food was "very nice" and another said they liked sandwiches and could always have them if they wanted.

We observed care being given with care, safety and dignity.

We viewed records which showed evidence that staff received training and support to carry out their job and had the required checks and employment history information.

We asked two people who lived in the home about the standard of the food they were given. One said it was “good” and the other said it was “excellent”. They said there were two choices at each mealtime and we asked what happened if they liked neither. We were told that the cook would provide something different that they liked such as an omelette.

We spoke to a relative of a person who had recently come to live at the home. They told us they were “very pleased with the staff.” We asked about whether they had been involved with a pre-admission assessment process for their next of kin. They said that they spoke to a member of staff who recorded events from her lifetime. They also said they had been asked to provide a more detailed written life story to support this. This relative commented that she had some concerns about some of her family member’s belongings being found in the rooms of other people. It was not clear how this had happened but we were assured that this did not involve any clothing. We asked a care worker about this and they were aware of the issue of residents lending items and sometimes people taking things without permission.

We spoke to two people who live in the home about how they found things. One said they were treated “very well” another said it was “all very good”. We were told by a third resident that the staff were “very good with the old people” and “those who are confused”.

We asked two people whether they got enough to drink particularly in the summer months when it would be hot in the conservatory. One said drinks were always given when they asked for them and the other told us that in summer jugs were placed out in the lounges.

We spoke to two people who live in the home about whether they ever felt worried and they said they did not. We also asked if they felt safe and they agreed that they did. These people commented that they thought the carer’s jobs were hard and they themselves would lose their temper. We asked if they ever saw that happening or heard any shouting. Both said that was never the case.

We asked a person living in the home what they would do if they were worried and they said they would speak to the home’s manger. They said of this person “you can talk to her”, “very good, one of the best”.

We asked people who lived in the home whether they had to wait for things to be done. One said that this happened “sometimes” but that it was not a big problem.