Magnolia House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed all quality statements within the safe key question. We found improvements had been made since the previous inspection. The service was no longer in breach of regulations relating to assessing and managing risk to people, protecting people from abuse and neglect, staffing levels and learning lessons when things went wrong. This meant people were now safe and were not at risk of avoidable harm. Safe systems were in place to manage risks relating to individual people and the environment, medicines, infection prevention and control, staffing, safeguarding, admissions and transfers and there was a learning culture.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Family members told us they were kept informed about any accidents or incidents and where necessary formal procedures under the Duty of candour had been followed. For example, one family member told us, “I’m keep informed if anything has happened and I think all necessary actions had been taken to reduce the risk of falls.”

The management team demonstrated they were open and transparent and learnt from any incidents, accidents or safeguarding events. They shared information with CQC and relevant health and social care agencies when required and sought advice and support. Staff reported accidents and incidents and were able to contribute their views about what happened and what they could do to reduce risks. Risks and events that had happened were shared at handovers with staff. All staff spoken to said they felt confident to raise any concerns.

Since the last inspection a number of improvements have been made and new policies, procedures and quality assurance processes have been introduced. These have resulted in an improvement in the overall quality and safety of the service and demonstrates organisational learning and continued improvement. There was a robust process in place to monitor incidents, accidents and near misses. This ensured all accidents or incidents were individually reviewed and prompt action could be taken should this be required.

People were supported to attend external health appointments. A family member told us that when they had supported their relative to attend a health appointment they were given an information pack by the staff to ensure hospital staff had any necessary information. This meant that any relevant information was shared and appropriate diagnosis or treatment decisions could be made.

Staff described the systems in place to ensure essential information was shared when people moved between services. The management team and staff told us they had good working relationships with external health and social care professionals and sought advice and support when needed.

External health and social care professionals were positive about their involvement in the service and felt staff and providers worked with them to ensure people received a safe effective service. For example, an external health professional said, “They will contact me and use our team as a resource should they have any concerns or seek advice when unsure of anything and have been open and transparent in my experience.”

There was a comprehensive admission process which helped ensure that only people whose needs could be safely met at Magnolia House would be admitted. Care records evidenced contact with the person, family members and external professionals involved in the person’s care as part of the admission process. People had hospital passport summaries of their care plans. These contained information on essential needs and could be easily printed and shared with other agencies as needed such as in the event of an urgent hospital admission.

People and their family members said they felt safe. A person told us, "I feel safe, everyone is so friendly”. Another person said, “They are lovely girls; nothing is too much for them.”

Staff had received safeguarding training and knew how to prevent, identify and report allegations of abuse. One staff member described the actions they had taken and said, “I have reported concerns that were addressed.” The management team understood the actions they should take if they had a safeguarding concern. The local safeguarding team confirmed that safeguarding concerns had been reported to them and investigated appropriately with the service.

People appeared relaxed and calm in the company of staff. We observed staff speaking to people in a respectful manner and including them in decisions. Staff responded promptly when people needed support, which reduced the risk of harm.

Appropriate systems were in place and followed, which protected people from the risk of abuse. Safeguarding concerns had been reported appropriately to CQC and the local safeguarding team. People who required them had Deprivation of Liberty Safeguards (DoLS) in place and the manager had an effective system to enable them to monitor applications and apply for renewals when needed. One person had conditions on their DoLS, which were met.

Risks were managed in a way to ensure people were able to be as independent as possible and could enjoy activities they liked doing. For example, one person had a diagnosis which meant they should avoid too many sweet foods however, they loved these. Therefore, staff supported the person to understand the risks and have these in moderation.

Discussions with staff showed they understood people’s individual risks and daily records of care showed staff were following risk mitigation measures.

Staff were available to offer support to people. We observed staff supporting people safely following people’s individual risk management plans.

Risks had been assessed and recorded, along with action staff needed to mitigate the risk. For example, risk assessments were in place for people at risk of falling, medicines management, skin integrity, nutrition, dehydration and mobility as well as medical conditions such as diabetes or epilepsy. Discussions with staff showed they understood people’s individual risks and daily records of care showed staff were following risk mitigation measures.

People confirmed equipment they required was available for them and used by staff.

The management team described robust systems in place to ensure they monitored the safety of the environment. Staff confirmed they had received relevant training to use equipment safely and that any necessary equipment such as for supporting people to move safely was available to them. Staff had received fire awareness training and understood the actions they should take should a fire occur.

The environment was generally well maintained with plans in place to redecorate some communal areas and bedrooms. We observed equipment had been serviced within the last year and was maintained safely. Our observations of the service and discussion with people, staff and leaders demonstrated environmental risks were safely managed.

Systems were in place to identify and manage foreseeable environment risks within the service, meaning people, visitors and staff were effectively protected from the risk of harm. Equipment was monitored and maintained according to a schedule. In addition, gas, electricity, electrical appliances, were checked and serviced regularly. Fire safety risks and risks posed by asbestos and from water systems, had been assessed where necessary action taken to ensure the environment was safe.

Most people and family members felt there were sufficient staff available to meet people’s needs in a timely manner. One person told us when they used their buzzer to get staff, “They come running.” However, another person said, “I think they are short of staff sometimes”, and a family member told us it was sometimes “hard to find a staff member” to let them out when they had completed a visit. People did tell us they were cared for by a consistent staff team who they had got to know.

Staff told us they felt there were usually sufficient staff to enable them to provide care without rushing people. Staff also told us they felt supported in their roles and received one to one supervision and regular training. Staff told us they worked as a team and one said, “Yes there is enough staff always. I like it here, good teamwork.” The manager and deputy told us they would support care staff when required which also meant they were able to monitor staff to ensure they were following all the correct procedures.

We observed staff were available to people and responsive to requests for support. There was a relaxed atmosphere in the home and staff had time to chat to people and support them in a calm and unhurried way.

Staff were recruited safely. This included checks on their suitability to work with vulnerable people. Although references from at least two previous employers had been sought the manager agreed to further strengthen recruitment checks to include evidence of satisfactory conduct in all previous health or care roles. Training was available for all staff and this was further strengthened by specific supervision meetings to monitor and assess their knowledge. Records showed most staff were up to date with training and systems were in place to monitor this and remind staff when further training was due. Staff had recently had training with an external dementia trainer to help them more fully understand the communication and support needs for people living with dementia.

People and their family members told us staff kept the home clean and wore personal protective equipment (PPE) when needed. One person told us, “Yes clean, they have a proper cleaning lady.” A family member said, “I think everything is kept very clean and fresh”, whilst another told us, “Yes think its kept clean – not noticed any problems with that.”

A member of the housekeeping team told us they had sufficient time to complete all necessary cleaning and described how they had tick boxes to ensure they did not miss anything. They told us this covered daily cleaning tasks and also deep cleaning of all parts of the home on a regular basis. Care staff confirmed they had undertaken relevant training and had access to all necessary PPE.

The environment was clean and staff were wearing personal protective equipment (PPE) when supporting people with personal care or when serving food. The manager undertook to ensure external clinical waste containers would be locked and told us about actions completed following an external infection control audit which we saw had occurred shortly before we were at the home.

There were policies in place to aid staff to understand the risks around infection control and what action they needed to take. Robust cleaning schedules and audits to monitor infection prevention and control measures were in place. Risks relating to infection management had been assessed and action taken to reduce these as far as possible.

People were supported safely with their medicines which they received as prescribed. A person said,  “If I need it I get it”. Another person told us, “They explain medications to new staff which is a good thing no problem.”

Staff confirmed they had received training in safely managing and administering medicines. They understood the actions they should take if they had any medicines concerns. The manager described how staff have their medicines competency checked annually or if there had been any errors.

Suitable systems were in place for the obtaining, storing, administering, recording, disposing safely of unused medicines and the auditing of medicines systems. Senior staff on each shift were responsible for administering medicines to people and this was done safely.