The Care Quality Commission (CQC) has downgraded the rating of a Crewe care home from 'requires improvement' to 'inadequate' and placed the home into special measures to protect people, following an inspection in August.

Mayfield House, run by Littleton Holdings Limited, provides support for up to 51 older people, including those living with dementia. At the time of the inspection 40 people were using the service.

CQC carried out this inspection following a notification of a serious incident in which a person using the service sustained a significant injury.

This incident is subject to further investigation by CQC as to whether any regulatory action should be taken.

CQC carried out the August inspection following a notification of a serious incident in which a person using the service sustained a significant injury (Photo: CQC).

This inspection didn't examine the circumstances of the incident. However, the information shared with CQC indicated potential concerns about the management and risk of falls for people leaving the premises without staff knowledge. This inspection examined those risks.

The home was previously in breach of legal regulations in relation to safe care and treatment and good management.

Improvements had not been made at this inspection, and it was still in breach of those regulations, as well as further breaches in relation to person-centred care, staffing, safe environments, safeguarding, consent to care and notifying CQC of incidents as required.

Due to the level of concerns found during this latest inspection, warning notices were issued to focus Mayfield House's attention on making immediate improvements regarding safe care and treatment, and how the home is managed.

Following this inspection, the ratings for safe and effective have declined from requires improvement to inadequate.

Responsive and well-led are rated requires improvement again, and caring has declined from good to requires improvement.

The service remains in special measures which involves close monitoring to ensure people are safe while Mayfield House make improvements.

Special measures also provides a structured timeframe so services understand when they need to make improvements by, and what action CQC will take if this doesn't happen.

The service remains in special measures which involves close monitoring to ensure people are safe while Mayfield House make improvements (Photo: Mayfield House).

CQC deputy director of operations in the north, Karen Knapton, said:  "When we returned to Mayfield House, it was disappointing to see a deterioration in the quality of care being provided since we last inspected.

"Ineffective risk management meant people continued to receive unsafe care, which is unacceptable in a place they call home.

"Leaders still hadn't made the necessary improvements they were told to make at the last inspection, to ensure the home was safe and tailored to people's needs.

"For example, there was no signage around the home to guide people with dementia and risk assessments hadn't been done to ensure the home's environment, including outside areas were safe.

"Whilst staff were patient and caring, leaders hadn't ensured they were sufficiently skilled to respond to people, especially those living with dementia.

"Some people appeared frustrated and distressed, but we saw minimal support, stimulation or activities offered to support their wellbeing.

"It was positive to hear, however, that managers were working with staff to make improvements. Staff were being supported with training and were fully involved in the development of future plans.

"We have told leaders where we expect to see rapid, and continued improvements and will continue to monitor the home closely to keep people safe during this time.

Mayfield House is located off Mayfield Mews in Crewe (Photo: Ryan Parker).

"The registered manager was responsive to our feedback and took action to make some improvements straight away.

"We will return to check on their progress and won't hesitate to use our regulatory powers further if people aren't receiving the care they have a right to expect"

Inspectors found that Staff didn't ensure people were involved in their own care planning and records weren't always accurate or up to date and leaders didn't always listen to concerns about safety and didn't always investigate and report safety incidents.

They also found that leaders didn't ensure risks to people were fully assessed and safely managed, especially for those living with dementia and staff didn't always assess or manage the risk of infection.

However, inspectors said catering staff made home cooked food daily with several choices available, people were offered various snacks and drinks throughout the day and people were supported to maintain contact with their loved ones.

Inspectors observed various visitors who all said they were made to feel welcome by staff.

The report will be published on CQC's website in the next few days.

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