Magellan House

Magellan House is a residential care home. The home is registered for up to nine young people living with a learning disability and/or autism. There were five people living at the home at the time of inspection. People had access to a communal lounge, dining area, activity room, sensory room and kitchen. People had their own bedrooms with en-suites.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Right Support: Staff supported people to have the maximum possible choice, control and independence and they had control over their own lives. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. Each person had their own en-suite rooms, which were personalised to meet their needs and preferences.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care: People received kind care. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. People’s care, treatment and support plans reflected their range of needs. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right Culture: People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes. Staff knew and understood people well and were responsive.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 18 March 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. This service has been in Special Measures since 18 March 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service on 10 September 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve staffing, safeguarding service users from abuse and improper treatment, safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to 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 Magellan House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Magellan House is a residential care home. The home is registered for up to nine young people living with a learning disability and/or autism. There were seven people living at the home at the time of inspection. People had access to a communal lounge, dining area, activity room, sensory room and kitchen. People had their own bedrooms with en-suites.

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

People were not always protected from abuse. Leadership was not always transparent and open about incidents that had occurred. The registered manager had not always taken action to respond and alert the local authority safeguarding team when alerted to suspected abuse.

Staffing levels were consistently below what was required to keep people safe. The registered manger and provider had not established, or implemented, appropriate staffing levels that either ensured that people were safe, or that they received the care they needed.

Risk assessments were carried out and guidance implemented for staff to support people. However, staff had not always followed this guidance to ensure that risks to some people’s health was mitigated. Some people were not always provided with the appropriate diet that promoted their health and dietary needs.

Relatives gave negative feedback about the running of the service. Relatives told us they felt let down by management and provider support and that communication with them was poor. Relatives were not assured for the safety of their loved ones due to the staffing issues. Relatives said that care staff were caring in their approach to their loved ones, but that staff turnover and low staffing impacted on the support they received. Relatives stated that they did not always feel that their family members received prompt and timely support for some health matters.

People were not always 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 always support this practice.

Infection and prevention control was well managed. People received their medicines safely and the service ensured that medicines were managed well. Staff received training that was relevant to the needs of the people living at the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe, effective and well-led, the service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• People were not always protected from avoidable harm. There had been an increase in safeguarding incidents between people, and staff were not confident that staffing levels supported them to protect people adequately.

Right care:

• People’s needs and preferences were known by caring staff, but consistent shortfalls in staffing levels meant that people did not always have access to meaningful occupation or receive the amount of support according to their assessed need. People were not always supported to maintain a balanced diet that promoted their health needs.

Right culture:

• People did not receive planned and coordinated person-centred support that was appropriate and inclusive for them. Leaders were not always transparent and did not promote an open culture at the service.

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 1 March 2019)

Why we inspected

We received concerns in relation to staffing, an increase in safeguarding concerns and the management of the home. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

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.

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

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

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

Following the inspection, the provider informed us that the registered manager was not at work and that their notice period was being served. The Deputy Manager informed us they were leaving their role in the immediate future. The Head of Residential services, together with a manager from another of the providers services, was to provide on-site governance support to staff. The provider informed us that they would be reviewing actions and requirements from recent safeguarding concerns. The provider sent us staffing schedules for the following two weeks following the inspection which showed an improvement in staffing numbers, although it was unclear whether these changes was sufficient to ensure that people were receiving their assessed and funded one to one hours.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding, staffing, duty of candour and governance 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

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

People were wearing the same personal protective equipment (PPE) as staff to promote an ‘all in this together’ approach. People who lived at the service had been involved in infection prevention control (IPC) training

Relatives were informed about the outbreak and interim arrangements to stay in touch with people were in place. Staff had found creative ways to support people to self - isolate in their rooms, this included 'room service' style catering where people were able to choose from a room service menu.

The registered manager had risk assessed storage of PPE, as PPE could not be stored around the premises. We observed staff using storage bags to carry all that was needed and then remove PPE on exit rather than donning and doffing stations.

Staff were carrying out additional high touch area cleaning. Staff had also considered communal games and craft items and these had been divided up and rotated to minimise spread of infection.

The registered manager had arranged for staff to split onto two teams that worked alternate shift patterns to minimise interaction between them. Staff told us they felt very well supported by the manager and provider.

Further information is in the detailed findings below.

Magellan House is a residential care home. The home is registered for up to nine young people living with a learning disability or autism. There were seven people living at the home at the time of inspection. People had access to a communal lounge, dining area, activity room, sensory room and kitchen. People had their own bedrooms with en-suites.

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

People’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; promotion of choice and control, independence and inclusion. People’s support focussed on them having as many opportunities as possible for them to gain new skills and become more independent.

People were safe from the risk of abuse. Staff had a flexible approach to risk management which ensured people could have new experiences and maintain their independence. There were sufficient numbers of staff to meet people’s need. A relative told us, “The staff are consistent and I think they are a fabulous team, they know our son so well.”

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff had the skills and knowledge to deliver effective care and support. People were supported to maintain a balanced diet and had access healthcare services as and when needed.

People were treated with kindness and respect. A relative told us, “The staff are so kind. I trust them with my precious daughter and I wouldn’t if they weren’t so caring.” People were supported to be involved in decisions about their care and given support to express their views. People’s independence was promoted and their differences respected.

Care was personalised to meet people’s care, social and wellbeing needs. People had access to a range of activities that met their interests. A relative told us, “They are out and about all of the time, taking part in activities that they would not have had access to before living at Magellan.”

People, their relatives and staff were complementary of the manager and staff felt well supported. A member of staff told us, “We are well supported and have regular supervision where the manager gives us feedback. She is great, really open and approachable.” The culture of the home was positive. Systems and process were in place to monitor the quality of the service being delivered.

Further information is in the detailed findings below.

Rating at last inspection:

Requires Improvement (28 March 2018). At this inspection the overall rating has improved to Good.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Good.

We undertook this focused inspection to check that the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Magellan House on our website at www.cqc.org.uk.

Magellan House is a 'care home.' People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Magellan House provides accommodation and personal care for up to nine people specialising in care for young adults with autism and learning disabilities who have communication and positive behaviour support needs, seven people were living at the service on the day of our inspection. They required support with personal care and had additional communication needs. Accommodation was arranged across two floors of a large house. The service is one of three residential care homes run by Pathway Healthcare Ltd, a specialist provider of care, support and housing services. The service had been developed in line with the values that underpin the Registering the Right Support guidance and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any other citizen.

The service had a registered manager. A registered manager is a person who has registered with the 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 home is run.

We inspected the service against two of the five questions we ask about services. Is the service well led and is the service safe? This is because at our previous inspection on 25 October 2017 we identified breaches of the Regulations. We issued a warning notice telling the provider to carry out improvements in the area of safeguarding people from abuse and improper treatment. We also asked the provider to carry out improvements in the area of medicines management.

At this focussed inspection on 29 March 2018 sufficient actions had been taken to address these issues. People were being supported safely with minimal physical intervention. Staff had received the training they needed to support people effectively. Incidents and accidents were recorded and monitored and staff understood their responsibility for safeguarding people. “One relative told us that the atmosphere at the home was calmer and they felt confident that their relation was safe living at the home.”

People’s medicines were managed, stored and administered safely. Staff had received training and there was clear guidance and protocols to support the administration of medicines. Records were accurate and there were systems in place to monitor and address any shortfalls.

Staffing levels were sufficient to support people’s needs. A relative spoke positively about the improvements they had noticed at the home and attributed this to having more consistency within the staff team.

Risks to people had been assessed and there was clear guidance for staff in how to support people. Positive Behaviour Support (PBS) plans were comprehensive and provided detailed guidance for staff in how to support people with complex needs and behaviours that could be challenging. A relative told us, “My relation is having a good quality of life now because staff understand how to support him, they recognise triggers and know how to address them.”

At the last inspection on 25 October 2017 we identified failings in governance arrangements. This was because systems had not always been effective in assessing, monitoring and improving the quality and safety of the service. Accurate records were not always consistently maintained. At this focussed inspection we found that improvements had been made and quality assurance systems were in place. However these systems were not fully embedded within practice and there remained some inconsistency in records.

Staff spoke highly of the management of the home and described visible leadership from the Registered Manager. A relative also commented on the welcoming and approachable atmosphere at the home.

The service had a registered manager. A registered manager is a person who has registered with the 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 home is run.

The provider was not consistently working within the principles of the Mental Capacity Act 2005. Mental capacity assessments were not in place to demonstrate whether people could consent or not consent to the use of restrictive practice. Accurate, complete and contemporaneous records had not been maintained.

Statutory notifications had not been routinely submitted to CQC by the provider. A notification is information about important events which the provider is required to tell us about by law. A quality assurance framework was in place but this had not always been effective in driving improvement and identifying shortfalls.

The management of medicines was not safe and the administration of medicines was not always undertaken in a safe manner. Staffing levels were maintained with regular use of agency staff, however, the provider could not consistently demonstrate that agency staff had the right training and skills to provide safe and effective care.

Safeguarding procedures were in place and where required the provider had raised safeguarding concerns. However, steps had not been taken to ensure that any outcomes of safeguarding enquiries had been met. Systems were not consistently safe in ensuring that people were protected from the risk of improper treatment. People were at risk of not always receiving personalised and responsive care.

Staff told us they worked as part of a team, that the service was a good place to work and staff were committed to providing care that was centred on people's individual needs. There was a strong caring culture in the care and support team.

People were supported to maintain good health through regular visits with healthcare professionals, such as GPs, dentists and the specialists involved in their specific healthcare needs.

Staff treated people as individuals. Staff were knowledgeable about people's likes, dislikes, preferences and care needs. They approached people in a calm, friendly manner which people responded to positively. Relatives spoke highly of the service. One relative told us, "They couldn't be in a better place."

People were encouraged to lead active lives and were supported to participate in community life where possible. People were empowered to access support from a range of services and staff worked alongside these organisations to support people when required.

There were sufficient numbers of staff to meet people's needs and to keep them safe. The provider had effective recruitment and selection procedures in place. Relatives confirmed that they felt their loved one was safe living at Magellan House. People, relatives and staff spoke highly of the registered manager. One staff member told us, "The manager is so lovely and approachable."

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered providers to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.