Mayflower Care Home

Mayflower Care Centre is registered to provide people with nursing and residential care. It can accommodate up to 76 older people living with dementia, nursing needs or end of life care. At the time of this inspection there were 75 people living in the service. The service is divided into five units. Diamond on the ground floor caters for up to 26 people who are frail. Sapphire and Opal units on the first floor provide care for up to 30 people. On the second floor Amethyst and Emerald units cater for up to 20 people with complex needs including behaviours that challenge themselves or others and mental health problems.

People’s experience of using this service

People and their relatives told us the service was exceptionally well-led which resulted in staff delivering a high standard of care. A relative had complimented the service stating, ‘I just wanted to make you aware of the outstanding job your team have done for my dad. A stressful time was made so much more bearable’.

We had received a compliment about the management of the service from a visiting health care professional. “I was blown away by the skills of all their staff to manage their residents with 'challenging behaviour'. The care home manager and trainer are passionate about their residents. This home deserves more than outstanding it deserves an award.”

Everyone described a positive culture at Mayflower where people were at the heart of the service. One relative told us, “Staff know what they’re doing, and their really good attitude and enthusiasm rubs off”. Another relative summed up the open culture of the service telling us, “They explain what they are doing and why. They don’t hide anything. Their response is excellent. The care I’ve seen, I couldn’t ask for anything more.”

Governance was well-embedded at the service and there was a strong emphasis on continuous improvement. This involved actively engaging and working in partnership with relatives. Comments from relatives included, "All through covid, they went over and above to inform us how they are keeping everyone safe and well. They’ve protected the residents and put in a really strict procedure to protect us all"; and I truly believe that Mayflower are supporting me as well as mum.” Relatives feedback told us they particularly appreciated the open access to their loved one’s daily care notes. One relative described this as, “Wonderful and hugely reassuring.”

Staff had opportunities to develop, were proud to work for the service and felt well supported. One staff member told us, “The manager is so very supportive. I could not ask for more.”

People continued to be protected from the potential risk of abuse. Individual risks were identified, and steps taken to reduce them. Staff had the guidance they needed to minimise harm to people whilst supporting independence.

Staffing levels were monitored so there were enough staff to meet people's needs. Recruitment practices were safe to ensure people were protected from the risk of unsuitable staff.

The service had systems and processes in place to safely administer and record medicines use. Medicines were administered in a timely manner. Some medicines with additional administration requirements were not being given according to the additional warning information. This was immediately addressed. Prescribed medicines and those awaiting return to the pharmacy were stored safely and securely.

We were assured that the service could respond to COVID-19 and other infection outbreaks effectively.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 30 August 2018).

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of care provision and previous ratings. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. This enabled us to look at the concerns raised and review the previous ratings.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. The overall rating for the service remains Good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mayflower Care Centre our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

• Staff told us that new admissions must have had a negative COVID-19 test in the 48 hours prior to admission. An isolation area set up on the top floor was used for new admissions and anyone who developed symptoms. The isolation area had dedicated staff, including a housekeeper and activity coordinator. People in this area had their temperatures checked two to three times a day. The registered manager told us how people who tested positive for COVID-19 were barrier nursed to protect other people using the service. People who moved in were isolated for 14 days. A COVID-19 test was undertaken before they moved to another part of the home.

• Visiting was by appointment in half hour time slots. One visitor per floor was allowed at any one time. If people gave their consent, relatives had secure access to part of the care planning system where they could view the ‘care story’ of their loved ones.

• There was a designated lead for cleaning and decontamination and staff told us about the decontamination process for mattresses and other furnishings. There was a dedicated decontamination room.

Mayflower Care Centre is registered with CQC to provide care for up to 76 older people with nursing needs who are living with dementia. The service provides support to people who are elderly, frail, have palliative care needs and who have complex needs and challenging behaviours. The service is divided into five units. Diamond on the ground floor caters for up to 26 people who are frail. Sapphire and Opal units on the first floor provide care for up to 30 people. On the second floor Amethyst and Emerald units cater for up to 20 people with complex needs including behaviours that challenge themselves or others and mental health problems. There were 69 people living at the service at the time of the inspection.

The service was run by a registered manager who was present on both days of the inspection visit. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection on 10 and 11 July 2017, the service was rated overall as Requires Improvement. We found breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people did not always receive their medicines as prescribed and people’s care records were not always accurate or assessable. The provider sent us an action plan on 11 October 2017 which stated that they would comply with the Health and Social Care Act 2008(Regulated Activities) Regulations 2014 by the end of November 2017.

At this inspection on 19 and 20 July 2018, we found that there had been improvements in the management of medicines and record keeping. Auditing processes were effective in identifying and addressing any medicines shortfalls. Staff continued to be trained and have their competency in giving medicines assessed to make sure people received their medicines as prescribed by their doctor to maintain their health. The electronic care planning system had been embedded. Staff accurately recorded information about people which could be easily accessed to give a clear overview of people’s health and well-being.

People and their family members said people were well cared for and felt safe. Staff knew how to recognise any potential sign of abuse and felt confident to report them to help keep people safe.

To keep people safe, assessments of risks to their safety and welfare had been carried out by registered nurses and action taken to minimise their occurrence. Health and safety checks were effective in ensuring that the environment was safe and that equipment was in good working order. Accidents and incidents were monitored and appropriate action taken in a timely manner to evidence that lessons had been learned.

The provided operated an effective recruitment process. They continued to monitor staffing levels based on people’s assessed needs to make sure there were sufficient staff on duty at all times.

People benefitted from a clean environment and staff knew what to do to minimise the spread of any infection.

People were supported to access health care services when needed. The provider worked in partnership with a range of healthcare professionals to ensure people received appropriate care and treatment. People had sufficient food and drink and were provided with choices at mealtimes.

Registered nurses were employed to provide the professional expertise required to respond to people’s often complex care needs. A staff training and supervision programme was in place and staff felt well supported.

People were supported to have maximum choice and control of their lives in line with the principles of the Mental Capacity Act 2005. The provider had taken the necessary steps to ensure that people only received lawful care that was the least restrictive possible.

Staff were kind and caring and treated people with dignity and respect. Regular staff knew people well and had developed positive relationships with them.

People’s needs were assessed and a plan of care had been developed which included their choices and preferences. Guidance was in place for staff to follow to meet people’s needs.

Activity coordinators and champions offered a range of group and one to one activities to people which were meaningful and included people’s hobbies and interests.

Information was given to people about how to raise any concerns they may have. Any issue raised had been investigated and steps taken to resolve the situation to people’s satisfaction.

Everyone praised the management of the service. They said the team were approachable and a visible presence at the service. The views of people and their relatives and staff had been actively sought to develop the service. Effective arrangements were in place for the service to learn, improve and assure its sustainability. Strong partnerships had been developed with other agencies for the benefit of people who used the service.

The new manager was in post and after the inspection was successful in their application to register with the Commission. They were registered as manager of the service on 4 September 2017. 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.

At the last inspection in November 2016, we asked the provider to take action to make improvements to ensure there were sufficient numbers of staff deployed to meet people’s needs. This was a continued breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan in May 2017 which stated that they had complied with all Health and Social Care Act 2008(Regulated Activities) Regulations 2014.

At this inspection on 10 and 11 July 2017, staffing levels had been increased to meet people needs. However, we found shortfalls in the management of medicines and records.

Staff had been trained and assessed as competent to administer medicines and monthly audits had identified and addressed any medicines shortfalls. However, it could not be assured some people had received their medicines as prescribed by their doctor to maintain their health.

The new care planning system could not be accessed by all senior staff in order to effectively monitor people’s health and well-being. Some people’s care and treatment records were not accurate which could result in them receiving inappropriate staff support.

The service had increased staff levels since the last inspection and continued to review if there were sufficient staff on duty at all times.

People and their family members said they were cared for in a safe place. Staff knew how to recognise any potential sign of abuse and report them in order to help keep people safe.

Assessments of risks to people's safety and welfare had been carried out and action taken to minimise their occurrence, to help keep people safe. Health and safety checks were effective in ensuring that the environment was safe and that equipment was in good working order. Accidents and incidents were monitored and action had been taken as appropriate.

A schedule of cleaning was in place to ensure the service was clean and staff knew the practices to follow to minimise the spread of any infection.

People accessed health care services when needed and the service worked in partnership with healthcare professionals to ensure people received appropriate care and treatment. People had sufficient food and drink and enjoyed the meals provided at the service.

Staff received relevant training which enabled them to support people with a range of needs. Staff felt well supported but had not all received regular supervision and training. The service was developing staff to address this shortfall.

Staff sought and received people's consent to the support they provided and in line with the principles of the Mental Capacity Act 2005. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The service had made DoLS applications, to ensure that people were only deprived of their liberty, when it had been assessed as lawful to do so.

Plans were in place to make changes to the environment so it was more suitable for people living with dementia.

Staff were kind and caring and treated people with dignity and respect. Regular staff knew people well and developed positive relationships with them.

People’s needs were assessed and a plan of care was developed which included their choices and preferences. Guidance was in place for staff to follow to meet people’s needs.

A range of group and one to one activities were available to provide people with meaningful activities. Regular meetings were held to monitor if the activity programme on offer was effective.

Information was given to people about how to raise any concerns they may have. Relatives said that when they had raised a concern, they had been listened to and the issue resolved to their satisfaction.

People, staff and relatives said the management of the service had improved with the establishment of a new management team. The team were approachable and a visible presence in the service.

The views of people were sought through relative meetings. Systems to monitor the quality of care were improving for the benefit of people.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

At our previous inspection of 5, 6 and 9 March 2015 we found the service was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) 2010 relating to staffing levels and management of medicines. We undertook a comprehensive inspection on 10 November 2016 to check that the service now met the legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Mayflower Care Home’ on our website at www.cqc.org.uk.

We found the action taken to address the breaches was not comprehensive. We identified that the provider was not meeting regulatory requirements and remained in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to staffing.

At this inspection, we found people had not always received safe and appropriate care. The registered manager did not always deploy sufficient staff to meet people’s needs safely.

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.

People told us they were happy at the service. People and their relatives said staff were kind and caring. Staff upheld people’s dignity and respected their privacy and confidentiality. Staff knew people well and understood their communication needs.

Staff knew how to protect people from abuse. The provider used a safe and robust process to recruit suitable staff. People received the support they required with their medicines. Staff managed and administered people’s medicines safely.

Staff identified risks to people’s health and safety and had sufficient information on how to protect them from harm. The registered manager ensured staff followed guidance in place to manage the risks safely.

Staff assessed and reviewed people’s needs regularly. People’s support plans had guidance for staff on how to deliver care. People and their relatives were involved in planning for people’s care. People received care which reflected their preferences and as planned.

Staff sought and received people’s consent to the support they provided. Staff supported people in line with the principles of the Mental Capacity Act 2005. The registered manager ensured decisions were made in people’s ‘best interests’ if they were unable to do so. Staff upheld people’s rights and appropriately supported those whose freedom was authorised to be restricted under the Deprivation of Liberty Safeguards.

People accessed health care services when needed. The service worked in partnership with healthcare professionals to ensure people received appropriate care and treatment.

People had sufficient food and drink and enjoyed the meals provided at the service. Staff made referrals about people’s dietary needs and monitored their food and fluid intake as required. People took part in activities they enjoyed at the service and in the community.

Staff received training and support that enabled them to plan and deliver people’s support safely and competently. Staff had regular supervision. The registered manager took action to address any knowledge gaps.

The registered manager sought people and their relative’s views about the service and used their feedback to make improvements. People knew how to make a complaint. The service had investigated fully and resolved complaints received in line with provider’s procedures.

The quality of the service was subject to regular checks and audits. The registered manager took action to address any areas requiring improvement.

People told us the food was lovely at the home. They said the staff were nice, they liked their rooms, which were warm enough, and the washing facilities in their rooms worked properly.

We observed good practice with staff having time and spending time talking with people or reassuring them, or just simply holding a hand when needed.

We saw good practice because risk assessments for bed rails took into consideration other less restrictive options, like low beds or a mattress on the floor by the bed and staff had been creative in finding other less restrictive solutions.

We found that although staff did offer choices and seek some verbal consent before offering care, the production of consent forms was not consistent and where people did not have capacity there were no legal systems for assessing capacity or obtaining consent to care and restrictions.

We saw that the service provided safe care, through carrying out initial assessments, planning care based on collating the required information and making decisions based on risk assessments. However, people did not always experience care, treatment and support that met their needs and protected their rights because the service did not involve the people who use the service in their care planning and care plans, had not provided people with an accessible person centred care planning tool to facilitate creating a person centred plan, and had not made the care plans available in any other more accessible formats to facilitate access and involvement. For example, large print, tape/CD, read out, pictorially supported or with language translation.

The last inspection report recorded a shortfall under outcome 13 (regulation 22) and set a compliance action. At this inspection we found that the shortfall had been met and the compliance action closed. We therefore found that there were enough skilled and qualified staff to meet people’s needs.

The last inspection report recorded a shortfall under outcome 14 (regulation 23) and set a compliance action. At this inspection we found that the shortfall had been met and the compliance action closed. We therefore found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The last inspection report recorded a shortfall under outcome 18 (regulation 16) and set a compliance action. At this inspection we found that the shortfall had been met and the compliance action closed. We therefore found that people using the service

could be confident that deaths of people who use services are reported to the Care Quality Commission so that, where needed, action can be taken.

People told us their relatives had "settled in very well" and "whenever they have needed help, they have always had the right help". Professionals who visit the home have commented they 'have no concerns with care provided' and 'generally quite happy with permanent staff, not so with agency'.

We found the provider had taken action to address the identified concerns around management of medicines and records.

Although the majority of people we spoke to said they were happy with the staff at Mayflower we found there were not enough qualified, skilled and experienced staff to safeguard the health, safety and welfare of service users. We also found staff were not receiving appropriate training to enable them to deliver care and treatment to service users safely and to an appropriate standard.

Following our inspection we were told by the provider they had failed to notify the Commission without delay, of all the home's expected deaths.

We found that the provider had taken action to address the identified concerns around staffing. It was noted that recruitment is still ongoing and the provider is taking appropriate steps to ensure that people are cared for by sufficient numbers of suitably qualified, skilled and experienced staff. Most people we spoke with recognised that the provider had made improvements in response to the concerns raised around staffing levels at our last inspection. Comments included 'The staff are very good and work very hard' 'Staff do their best; they come when I need them'. A few people we spoke with, including staff, told us that they still felt that more staff were needed at certain times of the day and at weekends to better support people with their care needs.

Although the majority of people we spoke with told us that they were happy with the standards of care and we saw examples of people being safely and appropriately supported; we found that the provider was not consistently maintaining accurate care records in order to protect people against the risks of unsafe or inappropriate care.