This inspection took place on 27 April and 10 May 2018 and was unannounced. At the time of our inspection there were eight people using the service.

Mayfield House 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 provider had recognised that the service provided was not in line with the values that underpin the ‘Registering the Right Support’ and other best practice guidance and had plans in place to develop a supported living service for the people living at the home to move to which would support these values. The values of ‘Registering the Right Support’ include choice, promotion of independence and inclusion to make sure people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager but they were not available at the time of the inspection.

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 February 2016 we rated the service as ‘Good’ and there were no regulatory breaches.

Prior to this inspection we were informed of changes in relation to the provider’s senior personnel and that an initial audit carried out by the new operations manager had identified issues of concern. We brought this inspection forward as a result of this information.

We found appropriate and timely action had been taken to make sure the environment was safe.

People told us they felt safe and staff understood their responsibilities in relation to protecting people from abuse.

Risk assessments and behaviour protocols were in place but were in need of effective review.

Medicines were managed safely and infection control systems were in place to keep people safe.

Staff recruitment procedures ensured staff were suitable to work in the care service. Staffing levels were sufficient and flexible to meet people’s needs.

The training matrix showed gaps in some staff’s training which meant not all staff had received the training they needed to support them in their roles. Not all staff felt they received effective support.

People accessed healthcare services as required. However we found the advice of healthcare professionals was not always incorporated into care plans or followed.

Although we observed people were offered choice, care plans did not support the ethos of supporting people to have maximum choice and control of their lives.

We recommended consent issues be reviewed to make sure the service is working within the principles of the MCA.

People told us they enjoyed the meals at the home and we saw they were involved in developing menus.

We saw staff were caring in their approach and had developed positive relationships with people and clearly knew them very well.

Care plans did not did not reflect any involvement of the person concerned and did not always reflect a caring or positive approach, with some appearing judgemental rather than demonstrating how caring practice was embedded and promoted within the service.

We saw staff supported people well with personal care but found people’s dignity needs were not always fully considered.

Improvements were needed to demonstrate a person centred approach to care planning.

People were involved in a wide range of activities but we did not see evidence of people’s choices with regard to activities being reviewed. People were supported to choose and enjoy an annual holiday.

Systems for auditing were not robust and although issues with governance had been identified, this had been as a result of changes of

We inspected Mayfield House on 10 February 2016 and the visit was unannounced. Our last inspection took place on 2 January 2014 and, at that time, we found one of the regulations we looked at was not being met in relation to respecting and involving people who use services. On this visit we found improvements had been made.

Mayfield House is a converted property which provides accommodation and personal care for up to 20 people with a learning disability. It is located in the King Cross area of Halifax and is close to local shops and amenities.

At the time of our visit there were 15 people using the service.

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.

People told us they felt safe in the home. Staff had a good understanding of how to control risks to people’s health, safety and welfare.

Staff were recruited safely and there were enough staff on duty to provide people with the care and support they needed. Staff had received appropriate training, supervision and support.

We saw staff knew people well and there was a warm and good humoured atmosphere in the home. People were supported to follow their interests in the community and a wide range of activities. Staff supported people to be as independent as possible and we saw people going out on their own or helping with cleaning and laundry.

Care and support plans were individualised and focused on what each person wanted to achieve and what support they required from staff.

We found people had access to healthcare services and these were accessed in a timely way to make sure people’s health care needs were met. The medication system was well managed and people received their medicines at the right times.

People told us meals were good and we saw the menus provided both choice and variety.

Mayfield House was well maintained and homely. People’s bedrooms were highly personalised and we found everywhere was clean and tidy.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).

We saw there were systems in place to monitor the quality of the service. When areas for improvement were identified action was taken to address the shortfalls. People using the service were asked for their views and staff responded to their requests.

This inspection was undertaken following the Care Quality Commission receiving information of concern relating to the care of people living at Mayfield House.

We visited the home over two days, on 30 December 2013 and 2 January 2014. On the days of our visit there were fifteen people living at Mayfield House. Accommodation was on the ground and first floor of the property with separate accommodation in the ‘cottages’ to the rear of the house. There was both a stair-lift and a passenger lift available for people to access the first floor of the main house.

We spoke with the manager, two senior care staff, three care staff and the housekeeper. All the staff that we spoke with were helpful, pleasant and co-operative.. We also looked at the support plans of five people who lived at Mayfield House.

We spoke with five people who lived at the service, their feedback was positive. There comments included:

“I’m generally happy; I’ve not been upset by anything.”

“The food is alright here....I choose what I want...but I like any food.”

“(It’s) good here, very good.”

People we spoke with told us they had regular contact with relatives and access to the local community. Each of the support plans we looked at contained a monthly summary of the daily entries staff made about a person’s care and support. These included their social and family contact and leisure activities.

The support plans we looked at were person centred and included detailed information about the support people required and their personal preferences.

Staff who worked for the service were aware of how to raise concerns about abuse and recognised their personal responsibilities for safeguarding people using the service.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. We looked at three training files and saw they included mandatory training and other training to ensure the staff had the skills to meet the needs of people who used the service

Information showed the service had a range of systems in place to help determine the quality of service the home offered. We were told by the manager, monthly meetings were held with people who used the service. We saw people were asked their opinion and were asked to make choices relating to their involvement in the running of the home.

We spoke with four people who live at the home. These are some of the things they told us:

“I like living here and I like the staff.”

“I like my bedroom.”

“I’ve been on holiday and I’ve had a good time.”

“I’ve been out today to play bingo.”

“The food is good.”

People told us they felt comfortable living at Mayfield House and said the staff looked after them well. They told us they were consulted, encouraged and involved in making their own independent living choices.