Inspection on 05/08/09 for Mayfield Care Home

This inspection was carried out on 5th August 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mayfield Care Home 06/08/08

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Mayfield Care Home Mayfield Care Home Beaufort Road Sale Manchester M33 3WR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kath Oldham     Date: 0 5 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 40 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 40 Information about the care home Name of care home: Address: Mayfield Care Home Mayfield Care Home Beaufort Road Sale Manchester M33 3WR 01619732371 01619732371 gilmours@runbox.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Stephen Reid Gilmour care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only. Care home only - code PC, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: - Old age not falling within any other category - Code OP The maximum number of people who can be accommodated is: 24 Date of last inspection Brief description of the care home Mayfield is a residential care home providing care and accommodation for 24 older people. New owners Steven and Julia Gilmour in Febraury 2008 purchased Mayfield and have plans to develop the accommodation and improve on the environment and care practice in the home. The home is situated in Sale, in a large Victorian detached property and is located at the end of a long drive and has secluded gardens. 0 Over 65 24 Care Homes for Older People Page 4 of 40 Brief description of the care home The original building has been extended to accommodate bedrooms on the ground and first floor. There is accommodation for three residents in the basement. Access to this accommodation is limited to those able to manage a number of fairly steep stairs. The kitchen is located in the basement and laundry facilities are on the ground floor. There is wheelchair access to the front and rear of the building and provision for parking at the front of the house. The garden was well maintained and gave a pleasant outlook. We were told the gardens are used by the residents to sit out in warmer weather. Fees charged for this service are between £364.30 and £450 per week. There are additional charges made for hairdressing, newspapers and toiletries. A number of residents pay for their own continence products. Care Homes for Older People Page 5 of 40 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This visit was unannounced, which means that the owner,manager, staff and residents were not told that we would be visiting, and took place on 5th August 2009 2009 commencing at 7:50am. We spent a little over ten hours at the home. The deputy and acting manager was available on the visit and provided us with information and records and support,in addition to the support from staff and residents.We also met briefly with the owner at the beginning of our visit. The inspection of Mayfield included a look at all available information received by the Care Quality Commission (CQC) about the service since the last inspection which was held in August 2008. Every year the owner,person in charge or manager is asked to provide us with written information about the quality of the service they provide.Some weeks before our visit Care Homes for Older People Page 6 of 40 the owners or manager was asked to fill in a questionnaire,called an Annual Quality Assurance Assessment (AQAA), telling us what they thought they did well, what they need to do better and what they have improved upon. This helps us to determine if the management of the home see the service they provide the same way that we do. We considered the responses and information the owner of Mayfield provided and have referred to this in the report. Mayfield was inspected against key standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. We are trying to improve the way we engage with people who use services,so we gain a real understanding of their views and experiences of social care services.We used an expert by experience on this inspection.An expert by experience is a person who has experience of using care services.They help us to get a picture of what it is like to live in or use a social care service.The expert by experience helps us get information to make judgments about the quality of life that people that use services have when using a care service.Comments from the Expert by Experiences report are used in this report. Comment cards were sent prior to the inspection for distribution to people staying and working at Mayfield the views expressed in returned comment cards and those given directly to the inspector and expert by experience are included in this report.We also send a comment card to residents for them to pass on to their relative, friends or advocates to obtain their views, opinions and feelings about the home. We got our information at the visit by observing care practices, talking with people staying at Mayfield talking with the owner and acting manager, deputy,some visitors and staff.A tour of Mayfield was also undertaken and a sample of care, employment and health and safety records seen. The main focus of the inspection was to understand how Mayfield was meeting the needs of residents and how well the staff were themselves supported to make sure that they had the skills, training and supervision needed to meet the needs of residents. The care service provided to three residents was looked at in detail to help form an opinion of the quality of the care provided.We call this case tracking.This is a way of inspecting that helps us to look at services from the point of view of the people who receive a service. We track residents care to see whether the service meets their individual needs. The term preferred by people consulted during the visit was residents. This term is, therefore, used throughout the report when referring to people living at Mayfield. A brief explanation of the inspection process was provided to the owner, deputy and acting manager at the beginning of the visit and time was spent at the end of the visit with the acting manager to provide verbal feedback. We have received two complaints about this service which were referred to the owner for investigation using the homes complaints procedure. We have received one safeguarding referral which was dealt with by the local authoritys safeguarding policies Care Homes for Older People Page 7 of 40 and procedures as it should be. References to we or us in this report represents the Care Quality Commission(CQC). Care Homes for Older People Page 8 of 40 What the care home does well: What has improved since the last inspection? The acting manager said that a system has been introduced to evaluate staff practice when administering medication to ensure they are confirmed as continuing to be competent to administer medication. This is to be formalised and include a record of this. We received a telephone call after our visit from the owner to say that a new controlled drugs cupboard has been purchased and installed. We were told the cupboard is compliant with legislation. Care Homes for Older People Page 9 of 40 Best practice has been adopted when administering temazepam controlled drug and it is recorded as such and kept in the controlled drug cupboard. We made a recommendation on our last visit to promote best practice,staff that are trained and are competent to administer medication should detail their initials,next to their signed name which should accompany the medication records.This has been addressed at the home. One or two social assessments are now in place that identifies past hobbies,interests, preferences then and now and remaining abilities and skills.This is to ensure that activities can be tailored to suit the needs of individuals.This work we were told was ongoing. The owners of Mayfield bought the property in February 2008 and have since that time invested money in modernising and improving the home. Since we last visited in August 2008 they have installed new windows in the house,repointed the building and have had the roof fixed. Some new dining room tables and chairs have also been replaced and the owners plan to buy some more to replace the old furniture in the dining room. New cupboards have been fitted in the dining room providing valuable storage space. New carpets have been fitted in the dining room which improves the safety of residents as the carpet down when the owners bought the house was showing signs of wear and tear. New lounge chairs have been purchased which improves the comfort of residents in the lounge. Flat screen televisions had been installed to promote residents enjoyment when watching television. The lounges have been decorated and new curtains bought. We were told that 10 bedrooms have been completely renovated since we last visited. The bedrooms that we looked at had been personalised by residents who have brought ornaments and small pieces of furniture. A passenger lift was in the process of being built and it was envisaged that this work would be completed in late August 2009. This will enable residents to mobilise independently rather than using the chairlift which is currently in use to the upper floor. The gardens have been improved and the main driveway has had some trees taken down to improve access to Mayfield.Residents commented on sitting out in the gardens and said that it is pleasant and quiet in the garden.A disabled ramp has been installed at the front of the house which helps people who have difficulty walking or who are in wheelchairs easier access to the home. A new manager and deputy have been appointed and are concentrating on developing the staff team and the practice and routines in the home.We were told that the acting manager has NVQ4 in Care and Management, and 2 of the senior staff have NVQ3.The owner told us,despite high turnover,the standards of care have improved and staff are more focused and aware of the required standards.Having a good manager and deputy Care Homes for Older People Page 10 of 40 in place has reinforced this. What they could do better: The wedging open of bedroom fire doors must be reviewed.The owner needs to speak with the Fire Authority regarding this and ensure that they are in agreement with wedging or propping fire doors open. Remove the stored items from the outside fire escape stairwell. The owner must also speak with the Fire Authority to ask advice in relation to the fire escape route from the back of the house to make sure they are aware of this and the action which should be taken to safeguard residents. To provide safeguards to residents and staff and to comply with regulations,ensure all staff have a criminal record bureau disclosure and a minimum of two written references before they start work at Mayfield care home. Develop the care plans to be more person centred so the care is specific to the individual and is reflective of the care and support residents need that is personal to that resident. This will ensure that residents get the care and support they need at a time and preference that they want. The acting manager needs also to further develop the care staff team to ensure they complete the daily and night reports everyday and night and include how a resident has been during the day and night, the care and support they receive and any presenting difficulties.This will demonstrate the needs and preferences identified in the care plan and evidence the care and support provided. We have made recommendations in relation to medication which need to be addressed to ensure and promote safe administration of medication. In order to ensure that activities can be arranged to suit the needs and preferences of residents, social assessments should be in place that identifies past hobbies and interest,preferences then and now and residents abilities and skills. Maintain a record of food served to residents in such detail that anyone examining the record could judge if the individual diet is sufficient. The acting manager needs to compile a menu in consultation with residents and or their families or friends which is designed to incorporate a choice of meals, the correct nutrition and appetizing to residents.Ensure that there is a menu in place so residents receive varied and their preferred meals at mealtimes and that residents are aware of the planned meals. Arrangements need to be made to test and record the temperatures of hot foodstuffs (hot food probes)in accordance with food safety regulations. Revise the working hours of domestic staff to ensure that care staff are not taken away Care Homes for Older People Page 11 of 40 from their caring roles when there are no domestic staff on duty. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 12 of 40 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 13 of 40 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information,and have their needs assessed before deciding to move into the home so they know that their needs can be met. Evidence: The acting manager told us that the owner had recently updated both the service user guide and statement of purpose and we saw that copies of these documents had been made available to residents. We were told in the AQAA completed by the owner before the visit that,No resident is admitted without an assessment. This assessment is carried out by two staff members, normally the manager and the owner. The results are documented and discussed with the family and relevant professionals. After 6 weeks the placement is reviewed and acceptance is confirmed. Any care issues are noted at this time and communicated to the family. Care Homes for Older People Page 14 of 40 Evidence: The expert by experience in their report said,I asked a few residents about their assessment when they first arrived at Mayfield, they were all very vague and only remembered being traumatised,frightened and resentful.One resident came from hospital after a long stay. We looked at the files of three recently admitted residents and all contained relevant pre-admission assessment information including summaries of the Care Management Assessments.The acting manager told us that all prospective residents whether privately funded or via social services care management arrangements receive a full assessment of their needs. Mayfield does not offer Intermediate Care services. Care Homes for Older People Page 15 of 40 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning was insufficient to demonstrate residents health and personal care needs.Medication arrangements did not fully promote the wellbeing of residents. Evidence: We were told by the registered owner that, Our care plans have now been fully implemented and are being used as planned.These plans enable the reader to see a full picture of the resident, including their initial assessments,risk assessments and daily care plans. We looked at the care files for three residents, two who were living at Mayfield long term and the third for a resident who was staying at Mayfield for a short stay. Since we last visited,the home have introduced a care plan booklet which keeps altogether the care needs of that person and follows a standard format. For one resident it described that they used a walking frame to get about. On our visit this wasnt used by the resident. Staff were not observed finding the frame or reminding the resident to use one.When residents needs change this should be recorded and a Care Homes for Older People Page 16 of 40 Evidence: true reflection of the care and needs identified and updated. The resident was recorded as having been weighed for the two months after their admission. There were no further record of them being weighed. The resident had lost weight from one month to the next. To check on residents health,weights do need to be made monthly or more regularly if this is needed. The care plan clearly stated, to be weighed monthly. The care plan identified that the resident needed night time checks hourly. It didnt say in the care plans what the purpose of these checks were. The acting manager said that residents receive two hourly checks and not hourly checks. A record is kept of some checks made to residents in the night but when we looked at this record for the three residents we were checking there wasnt a record that they had been checked. The records we saw to record night time support were not individualised to the resident as they should be but described a number of residents. To promote residents privacy they should be individualised. If these records are requested to be looked at by a resident they wouldnt be able to see them as they are kept now as they would see private detail about other residents that live at Mayfield. We couldnt get a sense of the care and support that residents receive as staff do not completed the daily progress reports daily. For one resident it recorded that they have a health problem. This was not recorded as having been checked out with the doctor or a district nurse for what appeared to be 21 days. When we looked further into this the same health problem had been identified 21 days later which was checked and medication prescribed at the time it was identified. It was not clear why the previous observation had not been followed through or if it had. The daily reports are a record of how the care plan is put into practice and should detail each day and night the progress of a resident, the support and care they receive or any presenting problems or difficulties for a resident. The way the daily reports are being completed at the moment does not demonstrate the care and attention received by residents, so you can not be sure that the care they need is provided to them. A resident in their comment card told us, in response to the question what does the home do well, cares for us as it should quite well, feeds us, keeps us clean and in response to our question what could the home do better said,as well as most homes do.Another resident told us, the staff look after me well and cant do any better for me.A further resident said, takes good care of me. A third care file was looked at for a resident who was staying at Mayfield on a short Care Homes for Older People Page 17 of 40 Evidence: stay for a period of about 12 days. The resident had stayed at Mayfield a couple of months previously. There was not a care plan in place for there most recent stay. It could be that the residents needs hadnt changed, however there was no detail to say this had been checked out. The resident was weighed shortly after admission and the records indicated a slight weight loss. There was nothing in the records to say this had been discussed with the resident or an explanation if there was any reason for this or if the resident was being checked to see if they were eating enough. To ensure that residents needs are assessed and action taken to maintain there health,safety,wellbeing and promote their abilities;staff do need to be clear what they are doing when they compile a care plan and need to demonstrate through accurate recordings the care and support provided to residents each day and night. We saw that other health care professionals such as district nurses and general practitioners were involved in supporting residents with their health needs.On this visit the acting manager confirmed that no resident had pressure sores. Those at risk did have pressure relieving equipment in place and records seen of visiting professionals demonstrated that matters of maintaining health were seen as important by the acting manager and staff of the home. The information provided in the AQAA told us,Our medication procedures are much improved and documentation is tighter.More staff have been trained to administer medication. We looked at the records which detailed the medication training received by staff who have the responsibility of giving out medication. We were told by the acting manager that she had received this training in her previous employment. The deputy manager didnt have a record that she had received training in medication but was administering medication on our visit. To ensure staff are confident and competent to give out medication they must have training in this aspect of there work which is if verified by the production of a certificate as confirmation. We made a recommendation on the last visit that the manager should introduce a system to evaluate staff practice when administering medication to ensure they are confirmed to be competent to administer medication.The acting manager said that this has been done informally but not recorded. Staff practice needs to be assessed and a record made so the acting manager is sure that staff are giving out medication safely. Mayfield used a pre-dispensed monitored dosage system for administering medication. We looked at the medication administration records which were being used at the time Care Homes for Older People Page 18 of 40 Evidence: of our visit. There were spaces where staff signatures should have been on particular times and days.It could not be confirmed by the records if residents had been given there medication as prescribed by there doctor. When staff give out medication this must be signed for on administration. There were handwritten entries on the medication administration records. This is when the doctor has prescribed additional medication once they have been printed by the chemist or if the chemist has missed of the medication from the printed sheets. When medication is handwritten on these records best practice is for staff to sign the record and a second staff member signs to verify that the entry has been made correctly as indicated on the prescription. This ensures that the medication is given to residents as it should be and as prescribed by there doctor to keep them well.This needs to be arranged at Mayfield. For a couple of residents the written detail didnt include how often the medication was to be administered on the handwritten instruction. This really does need to be included to make sure that residents get there medication as it is prescribed. The acting manager told us that the entries in the boxes do guide staff on the administration times. This isnt sufficient to safeguard residents. Some medication has a limited shelf life,like eye drops.The date they are opened should be indicated on the box and also on the bottle.This ensures that they are discarded at the right time. We looked at this type of medication for one person. The date of opening wasnt on the bottle or on the box. This needs to be arranged so it can be confirmed that medication is in date. The doctor had prescribed for some residents a variation in there dose of medication in that they could have one or two tablets for example. When this is prescribed by the doctor the staff should clearly indicate on the medication administration records how many tablets or spoonfuls the resident has been given. This is so an accurate and clear record is made of medication administered. Some medication prescribed by a residents doctor is to be taken when it is needed. For one resident they were prescribed medication for agitation this way. Residents are usually asked by staff if they need this medication and they can make the decision if they are in pain for example.There wasnt any written record on how staff decide when it is needed. This detail should be written in the care plan so staff are giving the resident the medication at the right time and should also describe what actions are taken by staff before medication is given. This information was not in this residents care plan so it was not possible to determine when or why this medication was given. Care Homes for Older People Page 19 of 40 Evidence: We reported on our last visit in August 2008 that the storage of controlled drugs needs to be changed, as there is new legislation in place, which indicates the changes in storage requirements. The storage of this type of medication remains as it was on our last visit. The CD cupboard is not complaint with current law (Misuse of drugs (Safe Custody) Regulations 1973. In the 2007 amendment this includes care homes. We were told on our visit that this was in hand.We were told by the owner by telephone two weeks after our visit that the new controlled drugs cupboard had been installed. We made a recommendation on our last visit to promote best practice,staff that are trained and are competent to administer medication should detail their initials,next to their signed name which should accompany the medication records.This has been addressed at the home. We made a recommendation last time we visited to refer back all medication,which is indicated on the medication recordsuse as directedto the residents doctor for clear instruction on how often this medication is administered.The medication administration records we looked at didnt have this direction on so this recommendation has been achieved. Care Homes for Older People Page 20 of 40 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily routines are flexible although the lack of social activities means some residents are not provided with a stimulating environment and may become bored Evidence: Two residents who completed a comment card said the homealwaysarranged activities that they can take part in if they want.Three residents responded,sometimes to the same question.There is a record of activities kept which details the activity some residents have taken part in.It was good to see that some residnets were having one to one activities organised to suit them or the circumstances.There were no entries in the daily reports on how the activities had impacted on the lives of the residents and whether it was something they liked doing. Social assessments were in place for some residents and for one we looked at it was informative and detailed,past hobbies and interests, preferences then and now and abilities and skills. This needs to be developed for all residents and the activities tailored to suit their needs. If didnt appear from the records we saw that some residents are able to pursue what they want or like to do. One resident liked to go for a walk each day. We couldnt see Care Homes for Older People Page 21 of 40 Evidence: from this residents records if this was done routinely. The expert by experience wrote in there report,A carer was giving one resident a manicure which is a great time for a personal chat and the resident was clearly enjoying the attention.We were told that a barbeque held a few weeks previously had been enjoyed by residents,friends and relations alike.I was surprised to see that no one was sitting outside among the plants or under the shady tree however,each resident outside requires a carer in attendance.There are no staff delegated to arrange activities for the residents,an exercise class with a tutor was arranged once a week but it wastoo much and was reduced to once a month.Board games,cards and dominoes etc would encourage child visitors to engage relatives to play but there was none of this.Books were quite plentiful and one resident had enjoyed a biography of Michael Barrymore.The resident also read the paper each day and tried to do the puzzles.The resident said (to the expert by experience),dont look at the magazines,those are for the men.A man comes occasionally and plays old tunes and some more modern ones on a keyboard.Staff said that is was the same every time and some residents made a point of leaving. On our visit a film was put on the television.The activity wasnt organised in a way to make it feel like an occasion. Attention to detail wasnt evident. Staff didnt move chairs or close the curtains for example or make the activity feel like an occasion. For some residents they thought is was just the television on. We made a recommendation on the last inspection to review the arrangements for residents having their meals to ensure that they have their meals where they want and are not influenced by staff routines to have meals somewhere else. This was in particular about breakfast when everyone was given there breakfast in there bedroom. Since we last visited this has been addressed by the home and residents are having meals in the dining room or in there bedroom if that is what the resident wants. One relative told us X really enjoyed coming down for breakfast. We also made a recommendation last time to maintain a record of food served to residents in such detail that anyone examining the record could judge whether the individual diet is sufficient. We looked at the records that the home kept. They werent in enough detail and didnt indicate what residents had eaten. The records indicated if residents had the menu but it didnt say what they had actually eaten for each meal. This record could be used by the acting manager if someone is loosing or gaining weight to check what they have eaten to see if its enough and whether they are having the right nutrition. Care Homes for Older People Page 22 of 40 Evidence: The meal at dinnertime is indicated in the lounge so residents are able to refer to this for reminders. We were told that one of the residents helped to make up the board each day with the menu. A relative told us that they,did not think the food was adequate and said residents were not given fruit to supplement the meals or fresh juice and they,brought in biscuits, chocolates and sweets. A nutritionally balanced menu each day should incorporate at least 1 portion of starchy food at each meal,2 portions of fruit,3 portions of vegetables, 2 portions of protein foods,2 portions of dairy food,a nourishing snack at supper and a milk drink,a portion of oily fish weekly. This couldnt be determined from the information available to us on our visit. A three week menu is displayed on the wall outside the dining room. The menu we were told isnt followed. It indicated a soup and main meal and sweet for the lunchtime meal which isnt provided routinely. We were told that residents didnt like the menu and variations are made to the menu and soup is not provided before the lunchtime meal. The meal on the inspection was sausage and mash, sweetcorn and cabbage. The meal didnt look particularly appetising. The alternative to the main meal was a sandwich. This isnt sufficient. Residents should be given an alternative hot meal at lunchtime. The meal served at teatime was not always indicated in the records so we couldnt really see what residents had for tea each day. Residents were seen to have toast and or cereal for breakfast and we were told that a hot breakfast is available on a Saturday but not every week in the summer. The expert by experience in their report wrote,I joined the residents in the dining room and made some observations.The room was small and very crowded and I remembered there were some residents eating in the lounge from bed tables.It was a hot,dry day but there were no open windows and both doors were fire safe.Each table had a pink fabric table cloth but no napkins.Most residents were wearing aprons or used green paper towels. The expert by experiences observations at the lunchtime meal also included these comments,A resident said they enjoyed there breakfast of toast and cereal and the warm drink and biscuit at bedtime.The lunchtime meal looked unappetising and was very little sausage,watery potato slices and sweet corn.Each person had a pale glass Care Homes for Older People Page 23 of 40 Evidence: of cordial.Dessert was a small portion of bread and butter pudding with a swirl of something resembling cream on top.Staff tried to persuade one resident to eat something;an alternative was not suggested.No salt or sauce was on the table.One resident ate the remains of there meal from the dirty apron. We were told in the AQAA that, We have made an effort to provide personalised activities as far as possible.This has involved identifying what activities appeal to certain residents and tailoring activities appropriately.Our new cook has been in post for about six months and the cooking has been more consistent and wholesome. Care Homes for Older People Page 24 of 40 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are listened to,taken seriously,and feel safe. Evidence: We were told in the AQAA completed by the owners before our visit that, As owners we take complaints seriously and always try to resolve the issue as soon as possible. Residents spoken with confirmed that they could speak to staff if they had any concerns and that action would be taken in response to their worries. All residents who completed a comment card said that there was someone they could speak to informally if they were not happy and knew how to make a formal complaint.Residents were comfortable approaching staff to ask questions or seek reassurance and the open door policy was appreciated by those consulted. A record is maintained of all comment or complaints made and the action taken to remedy the problem.This demonstrates that the owner and acting manager take residents, their family and friends and staff comments seriously and they record the action they have taken to try to put any problems right. We have received two complaints since we last visited Mayfield.Both of which have been referred to the owners for investigation using their complaints procedures. The responses from the owners took on board the comments received and offered solutions or learning experiences in their response to the Care Quality Care Homes for Older People Page 25 of 40 Evidence: Commission(CQC). The owner told us,All new staff get in house POVA training and are then sent on a training course as soon as practical. Discussions with staff and training records confirmed that staff receive training,including adult protection which helps them to understand their role in protecting residents. There has been one safeguarding referral which was dealt with through the local authoritys adult protection procedures as it should be. The owner had received some information about the Mental Capacity Act Deprivation of Liberty Safeguards and was awaiting information about when training about this was available so he could arrange for the manager and staff to attend. The owner has received this training.At the present time no one in the home was subject to an application made under these requirements. Care Homes for Older People Page 26 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The planned and ongoing refurbishments of Mayfield by the owners will further enhance the comfort, respect and privacy of residents. Evidence: The owners of Mayfield bought the property in February 2008 and have since that time invested money in modernising and improving the home. Since we last visited in August 2008 they have installed new windows in the house,repointed the building and have had the roof fixed. Some new dining room tables and chairs have also been replaced and the owners plan to buy some more to replace the old furniture in the dining room. The dining room walls were heavily scuffed and we were told this has been as a result of the old tables being banged on the walls. We were told that there were plans to plaster and repaint the walls in the dining room. New cupboards have been fitted in the dining room providing valuable storage space.There are currently no curtains at the windows in the dining room which when fitted may improve the appearance of the room. New carpets have been fitted in the dining room which improves the safety of residents as the carpet down when the owners bought the house was showing signs of wear and tear. Cooking staff have benefited from having a new oven, fridge and freezers in the kitchen and the dishwasher which needed repair has been thrown away.Staff were not Care Homes for Older People Page 27 of 40 Evidence: aware if the dishwasher was to be replaced but it was hoped that it would be as they felt this would help them to do there job effectively. On our visit the domestic was helping the cook with washing pots at lunchtime. We spent time in the lounges talking to residents and doing some paperwork.New lounge chairs have been purchased which improves the comfort of residents in the lounge. Flat screen televisions had been installed to promote residents enjoyment when watching television. The lounges have been decorated and new curtains bought. Visitors to the home told us that they felt the lounge didnt look homely and lacked some finishing and homely touches.The home was clean and free from unpleasant odours. The expert by experience in their report wrote, We moved to the lounge which has two sections, each with a number of lovely new armchairs and small tables.Two large screen televisions can be synchronised to play a film for everyone to enjoy.Alternatively,one lounge played the film and the other was quiet for those who wished to snooze, receive visitors or read. We were told that 10 bedrooms have been completely renovated since we last visited. The bedrooms that we looked at had been personalised by residents who have brought ornaments and small pieces of furniture. Some improvements still need to be made to some bedrooms in the house and we were told that this was in hand and a rolling programme of decoration and replacement of carpets and furnishings was in place. A passenger lift was in the process of being built and it was envisaged that this work would be completed in late August 2009. This will enable residents to mobilise independently rather than using the chairlift which is currently in use to the upper floor. The gardens have been improved and the main driveway has had some trees taken down to improve access to Mayfield.Residents commented on sitting out in the gardens and said that it is pleasant and quiet in the garden.A disabled ramp has been installed at the front of the house which helps people who have difficulty walking or who are in wheelchairs easier access to the home. The expert by experience wrote in their report, We approached the front door by a new ramp but I had to be lifted in my wheelchair over the step,fortunately I had help from my support worker and one of the builders. New windows have been installed which improve the appearance of the home. One resident said,its not draughty now sitting by the window and the windows look lovely they are big and you can see outside. Care Homes for Older People Page 28 of 40 Evidence: The owner told us, The home is clean and odour free. We take pride in keeping the home as clean as possible.We are spending a significant amount of money to improve the facilities by upgrading the infrastructure and improving the furnishings.This process is ongoing.The lawns and gardens have been well maintained and access down the driveway has been improved by the removal of several trees.A new patio area has been installed on the lawn for residents to use. A relative told us,They have seen all the improvements to the property and is delighted at the new standards of cleanliness and smart furniture. Care Homes for Older People Page 29 of 40 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment procedures are not robust and compromise the safety of residents and staff. Evidence: Information provided to us in the AQAA completed by the owner before the visit told us, We continue to hire and train staff in the way we want the care home to run. With our new manager and deputy manager now in place,we believe this process will be even better and staff stability can be achieved. We received a complaint in December 2008 to say that staff had started work without the necessary checks and criminal record bureau checks. The owner responded to this and said that they have tightened up their procedures to ensure that staff are recruited properly and in line with the Care Home Regulations 2001. We looked at staff files on this visit and we saw that one person started there induction training before a reference was returned and prior to a POVA first or criminal record bureau check being received.For a second person they started their induction before the CRB disclosure was returned. The contract for a third member of staff indicated their commencement date was in July 2008 before references and criminal record bureau checks were returned. Care Homes for Older People Page 30 of 40 Evidence: Staff should not start work until the POVA first check is back and should only work under supervision until a full criminal record bureau check is returned. Staff can start work in exceptional circumstances on receipt of the POVA first but only shadowing a member of staff. The manager must obtain a current Criminal Record Bureau certificate for all staff before they commence working at the home.This needs to be done before a new person starts work so that the owner can be sure they are suitable to work at the home. Failure to follow these regulations means that the owner does not know enough about someone in order to make a proper decision about whether they are suitable to work at the home.The practice of employing someone without the proper checks taking place first means that the owner does not fully safeguard residents from unsuitable people working at the home and reflects on the management of the home. Nine staff have obtained NVQ training at level 2 or above.The percentage of staff with this qualification exceeds the national minimum standards and enables staff to have the knowledge and expertise to provide support to residents.The acting manager said that training attended by staff has been collated in an effort to complete a training profile for all staff. This will assist in the organisation of training and provide a clear picture of staff training attended. Despite high turnover the owner believes that, the standards of care have improved and staff are more focused and aware of the required standards.Having a good manager and deputy in place has reinforced this. Training needs were identified through the staff supervision programme. All staff who were spoken to said they had opportunities to access ongoing training and development opportunities. A domestic is employed and the hours they work needs to be revised so that their are domestic staff on duty after 2.00pm each day. In the absence of domestic staff care staff would need to undertake this job which would take them away from providing care to residents. Care Homes for Older People Page 31 of 40 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and welfare of residents and staff could be compromised by the lack of fire safety records, staff practice and procedures. Evidence: Since we last visited the registered manager has left her employment at Mayfield.The acting manager has been in post since June 2009 and should be nominated for consideration as the registered manager with the Care Quality Commission (CQC).This means that she has to attend a fit person interview with the registration team at CQC and has to satisfy them that she has the skills and qualifications to be registered. We were told that the acting manager works closely with the owner to ensure all legislation is complied with.We were also told the acting manager has NVQ4 in Care and Management, and 2 of the senior staff have NVQ3.The owner told us, In between management appointments, and indeed while all managers have been working I have been spending at least 5 days a week at the home. The accident book details accidents, incidents and occurrences experienced by Care Homes for Older People Page 32 of 40 Evidence: residents. The current recording used at the home complies with Data Protection legislation. When we looked round the home we noticed that five of the residents bedrooms doors were wedged or propped open. Three of these rooms were on the ground floor and residents were in their rooms. We were told that some residents do like to have their bedroom doors open so they can see and hear the comings and goings in the home.In an emergency situation this practice compromises the health and safety of residents and staff as the doors which are fire doors will not act as a barrier to stop the spread of fire. Bedroom doors are fire doors and if they are propped or wedged open are not effective. We accept that some residents may want their bedroom doors open . However this must be risk managed to promote everyones safety and the procedures must reflect this. When we looked at the fire procedures it did not make any reference to the routine and practice of wedging or propping open fire doors. The owner must speak with the Fire Authority to make sure they are aware of this practice and routine. We didnt see anything in the homes fire risk assessment about this practice. From the first floor of the house there is a metal fire escape staircase which leads to the outside of the building. Outside,under the staircase there were cardboard boxes, old dining chairs and plastic chairs which could compromise the safety of residents and staff. This area outside is also used by people who smoke. Cigarette ends were discarded on the floor and around the fire escape staircase. There were no ash trays or suitable containers in which to dispose of cigarettes.The stored items need to be removed and instructions given that this area shouldnt be used as a storage area due to fire regulations.In addition,alternative arrangements need to be made for people to discard their cigarette ends safely. There is a fire exit at the back of the house leading from the dining room. There are steps down to the outside of the home. In the event of an emergency residents who have mobility difficulties or are in a wheelchair wouldnt be able to get of the house this way. The owner needs to speak with the Fire Authority to make sure they are aware of this and take advice on what action if any needs to be taken to safeguard residents. Examination of the fire records identified that they had not all been recorded as having been completed at the regularity prescribed by the fire authority. These need Care Homes for Older People Page 33 of 40 Evidence: to be undertaken regularly to ensure that equipment works.So if it is needed in an emergency Mayfield can be assured that the fire equipment, emergency lighting and means of escape are operational. We asked the acting manager to provide us with any additional information to confirm that the checks had been undertaken to date. The owner sent us some information that said, Means of escape,last check was 5th March 2009. The acting manager has subsequently signed off for monthly checks. Because of the building works both the acting manager and I have been checking the fire escapes on a daily basis, especially the basement and external fire stairs. I am satisfied that these checks were carried out, but were not properly documented. In relation to fire equipment the owner confirmed that the last check was on 16th January 2009 and for the emergency lighting 5th June 2009 as we saw on our visit and told us.Subsequent to your visit we have carried out and documented a satisfactory check. A quality assurance system is in place that seeks and acts upon the opinions of residents in terms of their day to day experiences and improvements that could be made.The owner has compiled a summary report of the findings of the questionnaire survey to residents and includes the findings to accompany the homes statement of purpose to evidence this consultation process. The requesting of comments about the service could be extended to include other professional visitors to the home which may include social workers or care managers. All residents and their relatives spoken to during this visit expressed satisfaction on how the home was run and the quality of services in the home. There is an established supervision process in place. Where staff meet with their manager to discuss their career development and their work and any training they feel is needed.The residents benefit from a staff team who are supported by the acting manager. We were told that Mayfield did not manage residents personal finances.Residents or their representatives managed them.There were small amounts of money held on behalf of some residents for the purchase of toiletries and such like. Care Homes for Older People Page 34 of 40 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 29 8,19 & Schedule 2 For the protection of 30/08/2008 vulnerable residents, robust recruitment and selection procedures must be followed at all times. To safeguard residents and staff fire doors within the home must not be wedged open 30/08/2008 2 38 23 3 38 23 To safeguard residents and 30/08/2008 staff, fire safety checks must be carried out and recorded as such at the regularity prescribed by the fire authority. Care Homes for Older People Page 35 of 40 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 28 18 Ensure all staff have a 11/09/2009 criminal record bureau disclosure and a minimum of two written references before they start work at Mayfield care home To provide safeguard to residents and staff and to comply with regulations 2 31 8 The manager must make an application for consideration to be registered with the CQC In line with regulations and to ensure the acting manager has the skills and qualifications and is a fit person to be registered. 31/12/2009 3 38 23 The practice of wedging 15/09/2009 open bedroom fire doors must be reviewed.The owner needs to speak with the Fire Authority regarding this practice and ensure that they are in agreement with Page 36 of 40 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action staff practice in relation to wedging or propping fire doors open. To promote the health and safety of residents and staff. 4 38 23 To ensure that fire equipment works correctly undertake the checks to the means of escape,fire equipment and emergency lighting systems at the regularity prescribed by the fire authority and record these checks. To promote the safety and wellbeing of residents and staff. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 15/09/2009 1 7 Develop the care plans to be more person centred so the care is specific to the individual and is reflective of the care and support residents need that is personal to that resident. This will ensure that residents get the care and support they need at a time and preference that they want. The acting manager needs also to further develop the care staff team to ensure they complete the daily and night reports everyday and night and include how a resident has been during the day and night, the care and support they receive and any presenting difficulties.This will demonstrate the needs and preferences identified in the care plan and evidence the care and support provided. Care Homes for Older People Page 37 of 40 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 2 9 Provide all staff who have responsibility to administer medication with training before staff are given this responsibility.Ensure that training quoted as having been taken by staff is confirmed by a certificate within staff personal files. Introduce a system to evaluate staff practice when administering medication to ensure staff are confirmed as continuing to be competent to administer medication. Ensure this evaluation is recorded as having taken place. To safeguard residents make sure that when entering handwritten details on the medication administration records that these are signed by the staff member making the entry and also signed by a second staff member to verify the medication has been correctly copied from the prescription.The medication records must clearly have written on them the regularity that the medication has been prescribed by the doctor. When residents are prescribed medication to be administered when it is needed and they are not able to let staff know when they need this medication that an assessment is made as part of the care plan to clearly detail when this medication can be given to the resident. Ensure that staff follow the procedures when giving out medication which includes the signature of staff on the medication administration records or a recognised symbol indicting that the residents do not want there medication which must be completed on administration. This will confirm residents have taken there medication or decided they didnt want it and that the medication administration records are maintained accurately. Make sure that when medication has a limited life that the date of opening is written on the bottle and packaging so that it is clear when this medication needs disgarding. When a residents doctor prescribes a variation to there medication for example one or two tablets or spoonfuls the number of tablets or spoonfuls is clearly written on the medication administration records. This will ensure that an accurate record is made of medicines administered to residents. Care Homes for Older People Page 38 of 40 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 3 12 In order to ensure that activities can be arranged to suit the needs and preferences of residents, social assessments should be in place that identifies past hobbies and interest,preferences then and now and residents abilities and skills. The acting manager needs to arrange additional opportunities for residents to take part in stimulation, occupation or activities individually or in groups to suit the residents staying at Mayfield. 4 15 Maintain a record of food served to residents in such detail that anyone examining the record could judge if the individual diet is sufficient. The acting manager needs to compile a menu in consultation with residents and or their families or friends which is designed to incorporate a choice of meals, the correct nutrition and appetizing to residents.Ensure that there is a menu in place so residents receive varied and their preferred meals at mealtimes and that residents are aware of the planned meals. Arrangements need to be made to test and record the temperatures of hot foodstuffs (hot food probes)in accordance with food safety regulations. 5 27 Revise the working hours of domestic staff to ensure that care staff are not taken away from their caring roles when there are no domestic on duty Remove the stored items from underneath the metal fire escape stairs outside the house and provide instruction that the stairwell must not be used as a storage area due to fire regulations The owner must also speak with the Fire Authority to ask advice in relation to the fire escape route from the back of the house to make sure they are aware of this and the action which should be taken to safeguard residents. 6 38 7 38 Care Homes for Older People Page 39 of 40 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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