Mayfield Road is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Mayfield Road accommodates twelve people with a learning disability in one adapted building. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion.

This inspection took place on 13 December 2017 and was unannounced. At our last comprehensive inspection of the service in October 2016 we gave the service an overall rating of requires improvement. We found the provider had not sufficiently addressed issues we had identified at a previous comprehensive inspection of the service in January 2016 and were in breach of the regulations because medicines were not managed safely and there was a risk that people did not receive 'as required' or covertly administered medicines safely. Some medicines were not stored at appropriate temperatures and medicines were not disposed of appropriately. We found the provider’s quality improvement systems were not always effective as the issues we identified at our previous inspection had not been improved. We also found care plan reviews were not always effective in making sure care records were kept up to date.

At this inspection we found the provider had taken action to make improvements and now met legal requirements. Information was available to staff to help them support people with their ‘as required’ medicines so that they received pain reliving medicines promptly and appropriately. Staff had access to the provider’s policies for homely remedies and covert medicines. This helped to ensure people received safe and appropriate support with their medicines in these specific situations, which adhered to their legal rights. People received the medicines prescribed to them. Stocks were regularly checked and accounted for and systems were in place to dispose of medicines safely. Medicines were stored safely and securely. The temperature of the room and fridge where medicines were stored was taken daily and was within safe recommended ranges so that people’s medicines would continue to remain effective and safe to use.

The provider’s audit systems were now used effectively to make improvements to the quality of care and support provided to people evidenced by the improvements made and sustained since our last inspection to medicines management arrangements. Senior staff undertook regular monitoring and audits of other key aspects of the service. When gaps or shortfalls in the service were identified required improvements were made promptly. People’s care records and associated documents were reviewed monthly to check these were complete, accurate and up to date.

Since our last inspection a new registered manager had been appointed at the service. A registered manager is a person who has registered with the 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. The registered manager was aware of their registration responsibilities and submitted statutory notifications about key events that occurred at the service as required. People and staff spoke positively about the management and leadership of the service. The registered manager promoted an inclusive and open culture in which people and staff were encouraged to share their views and participate in developing the service. The provider maintained arrangements to deal with people's complaints appropriately if these should arise.

People were safe at Mayfield Road. Staff knew how to protect people from the risk of abuse or harm and follo

This inspection took place on 26 October 2016 and was unannounced.

Mayfield Road provides personal care to up to 12 adults with epilepsy and a range of other needs, including those arising from acquired brain injuries, physical disabilities and learning disabilities. At the time of our inspection there were 10 people using the service. 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 in January 2016 we found the provider was in breach of the regulation about safe care and treatment because medicines were not managed safely. We rated the service ‘good’ but the key question, “Is the service safe?” was rated ‘requires improvement.’ At this inspection, we found the issues were not sufficiently addressed and the provider was still breaching the regulation about safe care and treatment. There were no protocols in place for administering ‘as required’ pain medicines or homely remedies, which meant we could not be sure people were able to receive these safely. Homely remedies are medicines that people can buy without a prescription. The policy to follow when giving people medicines covertly (without their knowledge) was not easily accessible to staff, which meant people were at risk of receiving medicines in an unsafe way or without their consent. There were no systems in place to ensure all medicines held at the service were accounted for or to ensure that excess medicines were disposed of. This meant medicines could be misused or lost without the provider knowing. Medicines were not always stored at appropriate temperatures, which could make them unsafe or ineffective.

We also found the provider was in breach of the regulation about good governance, because their audits and quality improvement processes were not effective in making the required improvements in their management of medicines. We also found out of date information in a care plan even though it had been reviewed recently.

We will add full information about CQC’s regulatory response to any concerns found during inspections at the back of this report after any representations and appeals have been concluded.

People were protected from harm and abuse, because staff knew how to report any concerns they had and there were systems to ensure staff did not use inappropriate restraint. Risk management plans were in place to keep people safe while restricting their freedom as little as possible. There were checks and management plans in place to ensure there was a safe environment for people to live in and the provider had systems to monitor accidents and incidents to identify any trends and address them.

There were enough staff to care for people safely, although the service was experiencing some problems with staff absenteeism. However, at the time of the inspection this problem was being addressed by the provider. They also vetted new staff to ensure they were suitable to work at the service. Staff received an induction, training, supervision and support from relevant professionals to equip them with the knowledge and skills they needed to work effectively, including specialist knowledge and advice on best practice.

The provider was meeting the requirements of the Mental Capacity Act (2005). This helped to ensure the correct legal procedures were followed when decisions needed to be made on behalf of people who did not have the mental capacity to do so for themselves. Where people needed to be deprived of their liberty to receive care, this was done within the appropriate legal framework to ensure people’s rights were upheld. Where people did have capacity, staff gained their consent before carrying out care tasks.

People

We undertook an unannounced inspection of this service on 28 January 2016. This was the first inspection at this service.

Mayfield Road provides accommodation, care and support for up to 12 people with epilepsy, some of whom also have learning disabilities and/or physical disabilities. Since Mayfield Road opened in August 2015 the home had been gradually moving people in to live there. At the time of our inspection seven people were using the service.

There was a registered manager in post who was one of the provider’s operations managers. The service manager who was in charge of the day to day management of the service was in the process of applying to become the 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.

Safe medicines management processes were not consistently followed. Whilst people had received their medicines as prescribed we identified that there were some stock and recording errors. This was a breach of a legal requirement and you can see what action we have asked the provider to take at the back of the main body of the report.

People received care and support that was personalised and their individual support needs were met. Staff were aware of what level of support people required and supported them in line with their preferences. Staff were aware of the risks to people’s safety and worked with them to manage and minimise these risks.

The provider’s medical team reviewed people’s health needs, particularly in regards to their epilepsy and seizure activity. Staff liaised with other healthcare professionals to ensure people’s health needs were met. Staff were aware of people’s dietary requirements and provided support in line with advice and guidance provided by healthcare specialists.

Staff were aware of people’s communication methods and involved them in decisions about their care. People were offered choice and support in line with their decisions and preferences.

Staff encouraged and supported people to identify what activities they enjoyed, and supported them to access activities at the service and in the community. The staff were in the process of further developing the activities on offer and working with people to develop individually tailored activity plans.

A new staff team were in place. Staff were aware of their roles and responsibilities, and were being supported to identify their strengths and embed these at the service. Staff received an in-depth training programme to ensure they had the knowledge and skills to support people. Staff were supported by their manager and received regular supervision.

Staff were knowledgeable about the procedures to follow in the event of an incident and if they felt a person was at risk of harm. The management team reviewed all incidents and liaised with the local authority safeguarding team if they needed any additional advice to protect people from harm.

Systems and processes were in place to review the quality of the service. This included formal monthly checks, management spot checks and reviews by relatives of people who used the provider’s other services. Any areas identified as requiring improvement were addressed and the necessary action was taken to improve service delivery.

The service manager was dedicated to improve the quality of the service and the support provided to people. They were liaising with the local authority to participate in good practice initiatives and were developing systems to obtain further feedback from people about the service.