The home was inspected on 5 and 6 April 2018 and the inspection was unannounced.

Mayfield 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. It accommodates 29 people in one adapted building. There were 23 people living at the home on the day we visited.

There was 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 our last inspection on 7 December 2016 we found that the provider was in breach of Regulation 17 good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of safe and well led to at least good. At this inspection we found that the provider had started to make the necessary improvements and that they had employed a new registered manager to drive the improvements forwards. The registered manager had identified all the concerns we found during the inspection and had plans in place to rectify issues.

At the last inspection the home was rated as Requires Improvement. At this inspection we found that the provider taken steps to improve the quality of care provided. However, while issues had been identified more time was needed to embed the improvements in the care provided. The rating remained as Requires Improvement. “This is the second consecutive time the service has been rated Requires Improvement.” However, the rating for the well-led question improved from requires improvement to good.

The environment was in need of attention to keep it at a standard which supported people’s dignity. Risks to people were identified and care was planned to keep people safe. However, pressure care had not always been delivered in line with people’s care plans. Care plans contained the basic information staff needed to provide safe care but they did not reflect people’s individual preferences. Medicines were safely administered and systems in place to order and monitor medicines were effective. However, where medicines were prescribed to be taken as required there were no protocols in place to support staff to administer these medicines in a consistent manner.

There were enough staff to meet people’s needs and checks were completed to ensure that they were safe to work with the people living at the home. Staff received training which supported them to provide safe care to people. However, they were not always up to date with changes in the homes’ policies and procedures. People were supported to make choices about their meals and their ability to eat and drink safely was monitored. Where needed soft food was provided so people could eat safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The registered manager had systems in place to identify concerns in the home and to drive improvements.

We carried out an unannounced inspection of the service on 7 December 2016. Mayfield Residential Home provides accommodation for up to 29 people who require nursing or personal care. Some of the people living at the home were living with dementia. On the day of our inspection 24 people were using the service.

A registered manager was in place. 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.

People told us they felt safe living at the home. Staff understood how to identify and report allegations of abuse; however these were not always reported to the CQC. The assessment of the risks to people’s safety was carried out. However, the environment in which people lived was not always safe, with storage cupboards containing potentially harmful cleaning products left unlocked and equipment such as wheelchairs and walking aids stored in communal areas. Accidents and incidents were investigated. People told us there were enough staff to support them at night, but raised concerns in relation to staffing numbers during the day. We saw staff did not always respond quickly enough when call bells were pressed. Our observations showed there were enough staff to support people on the day of the inspection. People’s medicines were stored in locked cabinets and cupboards, although on one occasion the room in which they were stored was unlocked. People’s medicine records were not always appropriately completed.

Attempts had been made to ensure the principles of the Mental Capacity Act (2005), including Deprivation of Liberty Safeguards, had been followed when decisions were made about people’s care. However, the documentation used to carry out the assessments did not always follow these principles.

People were supported by staff who had completed an induction and training programme, however agency staff did not always receive a formal induction. Some staff required refresher training in some areas and this was being addressed. Staff received regular supervision of their work. People spoke positively about the food provided at the home. People’s day to day health needs were met. The environment in which people lived did not offer sufficient support for people living with dementia.

There were some positive interactions between people and staff, but people were not always treated with respect and dignity by staff. People were involved with decisions about their care and support needs. People were encouraged to lead independent lives. Information for people on how to access independent advice about decisions they made was available. People’s records were not always stored securely. People’s friends and relatives could visit the home when they wanted to.

People and relatives felt the activities provided at the home required improving, with some people receiving little stimulation throughout the day. Only three out of seven days had a member of staff allocated to supporting people with their activities and hobbies and interests. People’s care records contained care plans to support staff with providing responsive care. People felt able to make a complaint and were confident it would be dealt with appropriately.

Auditing processes were in place, but these were not always effective and had not identified many of the areas highlighted in this report. The registered manager was not fully aware of their responsibilities to inform the CQC of incidents that could affect people’s lives. People, relatives and staff spoke highly of the registered manager. People were encouraged to become involved with the development of the service and were given the opportunity to give their opinions during ‘resident meetings’ and via regular reviews with the registered manag

During our inspection on 22 May 2014 we gathered evidence to help us answer our five questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes the number of different methods we used to help us understand the experiences of people using the service. We looked at records; we undertook observations throughout our visit, we spoke with three people and two relatives of people using the service and three staff members.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The provider informed us that no applications had been made to date and we saw that proper policies and procedures were in place.

In the care records we looked at we saw that risk assessments regarding people’s individual care and support needs were carried out and that measures were in place to minimise those risks.

Improvements had been made since our last inspection which we carried out on 11 October 2013. The provider was able to demonstrate to us that accurate records were kept in line with people’s care and support needs. However, we found inadequate evidence that an appropriate retention time period was maintained for their archived records.

Improvements had been made since our last inspection on October 2013. The staff calculator analysis tool that we looked at on the day of our inspection demonstrated to us that the provider took into account people's care needs when making decisions about the staff numbers and skills mix. This ensured that people's needs were met.

Is the service effective?

People living in this home and their relatives made positive comments about the care people received. One relative told us that, “The home always keeps me informed.” From our observations and on speaking to staff we saw that staff understood people’s care and support needs and knew them well.

Is the service caring?

Our general observations demonstrated to us that people were supported by kind staff. One person we spoke with told us that the home was, “Very nice, very good. Carers are very good as your needs are answered for.” A relative told us that, “Staff are polite and treat (relative) with dignity.” We observed that people were supported by staff at a pace they were comfortable with and were not rushed.

Improvements had been made since our last inspection which we carried out on 11 October 2013. During this inspection people and relatives of people we spoke with told us that they had no concerns over the homes laundry and that their clothing did not get mislaid.

Is the service responsive?

People’s care records we looked at confirmed people’s preferences, interests and we saw that people’s diverse needs had been recorded. We found that the care and support met people’s wishes.

We saw that people had access to activities should they wish to take part and that the home encouraged visitors to help support people maintain relationships with their relatives and friends.

Is the service well-led?

People we spoke with told us how staff assisted them with the care and support that they had agreed to.

Since our previous inspection which we carried out on 11 October 2013 we now found that quality monitoring systems were in place so that people were listened to and were safe from the risk of unsafe and inappropriate support and care. However, some quality checks undertaken did not always record any actions required or completed as a result of their findings.

People using the service and their relatives were asked for their feedback on the service provided. People said that they were aware of how to raise concerns and that they would be confident to do so.

On the day we visited there were 25 people living at Mayfield Residential Home. We spoke with nine people who lived at the home, three members of staff and the manager.

We saw the provider did not respect people’s personal belongings, laundry was not returned to the correct person. A relative told us, “A lot gets lost, you will see XXXX wearing a jumper that is not theirs.” They added, " XXXX does not like it when stuff goes missing.”

People told us they were happy with the care they received. One person said, “It’s pretty good really, the carers are very kind and have always got time to listen to you.” Another person told us, “I am very comfortable here, I have small moans every now and then but I am comfortable.”

There were not enough qualified, skilled and experienced staff to meet people’s needs. One person told us, “I would like my breakfast earlier, “I didn’t have it until 10:30am. I got up at 8:30am.”

We saw systems to monitor the quality of the service were not always robust. Gaps in records did not support people to receive safe appropriate care.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We spoke with three people who lived at the home and one person who was staying for a respite care break. People’s comments were positive about the service they received. One person said, “I do like it here, I can’t say I dislike it. The staff are good, they do look after you, they have been very good to me.”

Another person told us, “I am very, very happy here. The food is excellent, I’ve never not been satisfied” and, “I get well looked after, the staff are nice. I have no complaints.”

Some of the people that lived at Mayfield Residential Care Home had dementia and therefore not everyone was able to tell us about their experiences. During lunch time we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people’s experiences at mealtimes were.

The SOFI tool allowed us to spend time watching what was going on in the service and helped us to record how people spent their time and whether they had positive experiences. This included looking at the support that was given to them by the staff. We spent 45 minutes watching at lunch time and found overall people had positive experiences. We saw staff spoke with people at an appropriate pace and treated them with dignity and respect.

We spoke with a relative who was visiting the home. They told us, “Mum’s safe and well looked after,” and, ”I’m more than happy.”