Magnolia House

Magnolia House is a residential care home providing personal care for up to 40 people. The care home accommodates people within one large, adapted building, with access to floors by lifts or staircases. The service provides support to older people whose needs included physical needs and dementia. At the time of our inspection there were 29 people using the service.

People’s experience of using this service and what we found

Whilst people and their relatives told us they felt safe in the service, we found risks to people were not safely managed. Risks had not always been assessed or monitored and staff did not have guidance to effectively reduce those risks. Care plans and risk assessments did not identify essential information to ensure people were supported in a safe way.

People were not receiving safe care. For example, staff did not have sufficient information to be able to ensure they understood how to manage risks to people from pressure injuries, choking risks, falls, specific health conditions and behaviours that posed a risk to others.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff had not all received up to date training in safeguarding. Although they were able to describe actions they would take if they suspected or witnessed any abuse, we found not all safeguarding incidents had been acted upon. This meant people had continued to be at risk of harm.

There was a process in place for incidents and accidents to be recorded. However, records we reviewed were not always fully completed and had not been reviewed by the management team. This was important to ensure action could be taken to address issues when needed and prevent a reoccurrence.

Not all staff had received appropriate training to ensure they had the skills and knowledge to effectively support people. Staff had not had regular supervision to ensure they were helped to develop their skills and supported in their role.

Staff response times to people using their call bells for assistance were very poor. The management team had not carried out audits of the call bell system, which would have enabled them to identify where improvements were needed. This meant we were not assured people received support in a timely way.

People were not always treated with dignity and respect and staff were task focussed. We observed staff interactions with people using our short observational framework. This showed although some staff spoke to people with kindness and were caring, those people who were unable to easily hold conversations did not receive meaningful engagement from staff.

People received enough to eat and drink and told us they enjoyed the food. However, information was not clearly recorded when people needed a modified diet or were at risk of choking.

People were supported to access healthcare services when required. However, information relating to people's health needs was not always clearly documented within people's care plans.

Most people and their relatives told us they understood how to complain and would feel comfortable to do so. However, the leadership of the service was poor with limited management oversight. Quality and safety monitoring systems were not robust. This meant the provider and registered manager could not be proactive in identifying issues and concerns in a timely way and acting on these.

Governance processes and systems in place to help ensure the safe running of the service had not identified all the concerns we found. CQC had not been notified of significant events as required. This led to missed opportunities for ensuring the quality of care people received was of a good standard and safe.

Recruitment processes were safe to ensure only suitable people were employed. The service was clean and infection control measures were in place. People’s medicines were managed and administered safely.

People and relatives felt staff were kind and welcoming. We observed staff speaking to people with kindness.

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 September 2017).

Why we inspected

The inspection was prompted in part due to concerns received about how the service assessed and met people’s needs and managed risks. A decision was made for us to inspect and examine those risks.

In addition, the inspection was prompted in part by notifications of two incidents following which, 1 person using the service died and another came to serious harm. These incidents are subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of these incidents. However, the information shared with CQC about these incidents indicated potential concerns about the management of risk of falls and monitoring in place and the management of behaviours that pose a risk to others. This inspection examined those risks.

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.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to risk management, staffing, consent, dignity, governance and failing to notify the commission of significant events, at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

We found the following examples of good practice.

Comprehensive communication arrangements were in place to ensure staff were kept updated about COVID prevention measures and safety arrangements within the home. Communication systems with family members had also been enhanced to help ensure they continued to have confidence in the service.

Changes had been made to the environment to enable the challenges of providing safe care during the pandemic to be met. For example, a bedroom had been converted to provide a staff changing room and office space had been increased to enable distancing for staff.

Vulnerable staff were risk assessed and supported to manage any health conditions or to shield if required.

There were processes in place for staff and essential visitors to the premises. There was a designated area for putting on and taking off disposable protective equipment (PPE), which was provided to ensure the correct standards of PPE were worn, following government guidelines. All visitors were given clear information, which meant they understood how to maintain people’s safety whilst visiting.

There were PPE stations throughout the communal areas, and corridors. The service was clean and there was signage, reminding everyone to wash their hands and wear PPE. The provider was confident about PPE supplies

Further information is in the detailed findings below.

At the last inspection the service was rated Good. At this inspection we found the service remained Good.

Magnolia House is registered to provide accommodation and personal care services for up to 46 older people and people who may be living with dementia. At the time of our inspection there were 39 people living at the home. The service is set over three floors accessible by passenger lifts and has a range of communal areas for people to use, including a communal lounge, quiet lounge, conservatory and dining room. The majority of bedrooms are for single occupancy and many have ensuite facilities.

The provider had arrangements in place to protect people from risks to their safety and welfare. Arrangements were also in place to store medicines safely and to administer them according to people’s needs and preferences. People were supported to access healthcare services, such as GPs and community nursing teams.

Staffing levels were sufficient to support people safely and in a calm, professional manner. Recruitment processes were followed to make sure only workers who were suitable to work in a care setting were employed. Staff received appropriate training and supervision to make sure they had the skills and knowledge to support people to the required standard.

Staff were aware of the need to gain people’s consent to their care and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The arrangements included processes and procedures to protect people from the risk of abuse.

People were supported to eat and drink enough to maintain their health and welfare. They were able to make choices about their food and drink, and meals were prepared appropriately where people had particular dietary needs.

People found staff to be kind and caring. They were encouraged to take part in decisions about their care and support and their views were listened to. Staff respected people’s individuality, privacy, dignity and independence.

Care and support were based on plans which took into account people’s needs and conditions, but also their abilities and preferences. Care plans were adapted as people’s needs changed, and were reviewed regularly.

People were able to take part in leisure activities which reflected their interests and provided mental and physical stimulation. Group and individual activities were available if people wished to take part.

The home had an open, friendly atmosphere in which people, visitors and staff were encouraged to make their views and opinions known.

Systems were in place to make sure the service was managed efficiently and to monitor and assess the quality of service provided. The provider took action where these systems found improvements could be made.

Although we were not able to have a conversation with some other people we met them and observed some of their care and staff interactions in communal areas. We spoke with one visitor. They were very positive about the care their relative was receiving. We also spoke with two visiting health professionals. Both told us they were consulted appropriately and felt their guidance and treatment plans were followed. They also said there was always a member of staff who was aware of the issues and person's needs available to support them.

We spoke with a total of 14 staff. Some were on duty and other staff were attending the home for a training session. Staff were aware of how people should be supported, individual likes and dislikes and the help they required. Staff felt they had sufficient time to meet people's needs, had completed a relevant induction and had ongoing training. Staff told us the home was well staffed and they were able to attend to people as needed. We found there were appropriate recruitment, induction and staff support procedures.

The care we observed and described by staff corresponded with care plans and risk assessments viewed. The home was clean and there were systems in place to manage infection control risks. There were also systems in place to monitor the quality of the service provided.

Other people had dementia and therefore were not able to tell us about their experiences. To help us to understand the experiences people had we used our Short Observational Framework for Inspection (SOFI2) tool. This allowed us to spend time watching what was going on and helped us understand how people spent their time, the type of support they got and whether they had positive experiences. We observed that staff were courteous and respectful of people's views. Choices were offered and where necessary informal consent was obtained. Staff knew what support they needed and respected people's wishes. The support that we saw being given to people matched what their care plan said they needed.

We also spoke with visitors to the service, relatives and external professionals. They were generally positive about the home and care people received although they felt that staff were very busy. We found that people received an appropriate diet, medication was correctly managed and staffing levels had been adjusted to meet increased needs at night. Care plans were relevant to people and the necessary records were maintained.