The Magnolia Care Home

The Magnolia Care Home is a residential care home providing accommodation for persons requiring personal or nursing care to up to 38 people. At the time of our inspection there were 30 people using the service.

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

People felt safe and happy at the home.

Systems were in place to reduce the risk of harm to people. People and their relatives said people were safe, and knew how to raise a concern if needed.

Staff understood people’s care needs and how to meet these. An electronic care planning system was in place which was used by all staff to record daily information, and keep records up to date.

People were supported by enough staff to meet their needs. Staff knew people’s preferences and supported them to make choices. People were supported to have contact with family and friends.

People received their medicines as prescribed.

Measures were in place for the safe emergency evacuation of people.

A programme of improvement had taken place. People and staff told us the culture within the service had changed, and how positive outcomes were achieved for people.

Audits, checks and oversight was effective. The management team knew and understood people and the staff team well, and took prompt action when required.

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 Oct 2021) 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 11 March 2021. 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 undertook this focused inspection to check the provider 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 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 Requires Improvement. This is based on the findings at this inspection.

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

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 Magnolia Care Home is a residential care home providing personal and nursing care to up to 38 people in one adapted building. At the time of the inspection there were 19 people using the service.

Since the last inspection the provider stopped providing nursing care and de-registered this regulated activity from their Care Quality Commission (CQC) registration.

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

A sustained period of management instability meant the pace of improvements since the last inspection was negatively impacted. A new manager started in June 2021 who was not yet registered with the CQC.

People remained at risk of receiving unsafe care. Not all fire safety risks had been fully addressed. Shortfalls in emergency evacuation documentation were found. The process for completing and updating risk assessments associated to people's care remained ineffective. An electronic care planning and recording system had recently been introduced and needed to embed into practice. Improvements to recording practices were ongoing.

There was no effective system to learn lessons when things went wrong. Improvements to incident and accident reporting and investigation processes were in progress.

Areas of poor practice were identified which meant people remained at risk of not receiving their medicines safely and as prescribed. Improvements were found in some aspects of medicines administration and recording.

Some improvements were found in quality assurance processes but continued shortfalls remained. The provider could not assure themselves effective systems were in place in all areas of the service. Oversight of the new electronic care planning and recording system was not fully established. Audit processes did not always pick on up issues to be addressed. A person centred and positive culture was not fully embedded among the staff team to support people achieve good outcomes.

Checks were in place prior to new staff starting work to ensure their suitability to work with vulnerable adults.

Good infection control practices were in place. There was sufficient supply of personal protective equipment (PPE) available including hand sanitiser, gloves, aprons and masks. Processes were in place to facilitate testing for COVID-19 and safe visiting arrangements.

Improvements had been made to people's care plans since our last inspection although gaps remained. All care plans were being rewritten and an action plan was in place to track progress. Staff knew people well and had good relationships with them. People were supported to maintain relationships with their relatives and friends.

Activities and opportunities to pursue interests were limited. Improvements were found in end of life care planning and recording.

Positive feedback was received about the new manager. They had the experience and knowledge to drive improvements in the service over time. People and relatives gave positive feedback about the care provided in the service. Staff felt supported by the provider and management team.

The provider and management team were supportive of the inspection process. The provider remained committed to making and sustaining improvements in the service. The management team were working closely with the local authority improvement team using an action plan to prioritise tasks and track progress.

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 12 March 2021) and there were multiple breaches of regulation. CQC issued warning notices for breaches of regulations 12 (safe care and treatment) and regulation 17 (good governance) and gave the provider a short timescale to make improvements. The service was placed in Special Measures.

At this inspection we found some improvements had been made but the provider was still in breach of regulations. The service will remain in Special Measures at this time because two of the Key Questions remains rated inadequate.

Why we inspected

We undertook this focused inspection to check whether the Warning Notices previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met, and also check whether the Requirement Notice in relation to Regulation 9 had been met.

This report only covers our findings in relation to the Key Questions of Safe, Responsive and Well-Led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained inadequate. 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 The Magnolia Care Home 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 continued breaches in relation to people receiving safe care and treatment and good governance arrangements in the service.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains 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 six 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.

This service has been in Special Measures since 11 March 2021. During this inspection the provider had not demonstrated that enough improvements have been made.

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.

The Magnolia Care Home is a residential care home providing personal and nursing care to 28 at the time of the inspection. The service can support up to 38 people in one adapted building. Many of the people using the service were living with dementia. Accommodation is over two floors and there are spacious dining and communal areas on the ground floor.

The provider is in the process of de-registering the nursing element of the service. When this is completed, they will no longer provide nursing care.

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

The systems in place to assess, monitor and manage risks to people’s health, safety and welfare were ineffective. Timely action had not been taken to implement recommendations from the last fire risk assessment. People were at risk of harm because risk assessments were not always in place for identified areas of risk. Risk assessments were out of date and not regularly reviewed.

Up to date grab sheets were not available to give health professionals key information if people were admitted to hospital. Effective systems were not in place to ensure incidents and accidents were followed up consistently or that lessons were learned to reduce the risk of recurrence. Medicines processes in the nursing unit were not safe in all areas.

The provider failed to have effective systems in place to assess, monitor and improve the quality of the service. Quality assurance processes had not identified widespread issues with care records, risk assessments and medicines which placed people at heightened risk of harm

We have made a recommendation for the provider to review calculations of staffing levels. We could not be assured sufficient staffing were available to offer consistent person centred care.

Not all care files included assessments of people's needs prior to moving into the service. Staff support and development through specialist training and regular supervision required improvements.

Mental capacity assessments and best interest decisions were not in place to ensure decisions were appropriately made when people did not have the capacity to make their own decisions. People were not supported to have maximum choice and control of their lives and staff did not 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.

Monitoring of people's daily care needs was not consistent which placed people at higher risk of receiving unsafe care. DNACPR (Do Not Attempt Cardio Pulmonary Resuscitation) documentation required urgent review to ensure accuracy.

Systems were not in place for people and relatives and/or representatives to be involved in the care planning and review processes.

We observed warm interactions between staff and people living in the service and staff were kind and caring. Staff who had worked in the service for a while knew people and their preferences well.

Infection prevention and control measures, including a new audit process, were good. Staff followed government guidance in this area to keep people safe during the pandemic period. The décor and furniture in communal areas was fresh and clean, and bedrooms were suitable for people to live in.

Staff were checked for suitability for their roles prior to starting work. This included a police check with the Disclosure and Barring Service.

The provider had completed a comprehensive audit the week before the inspection visit which had identified the issues we found. They were open and transparent throughout the inspection. The provider was aware of the breadth and scale of improvements required in order to ensure people’s care was safe and met all of their physical and emotional welfare needs. They were committed to implementing and embedding improvements and had placed an operations director in the service full time to support their action plan.

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

The last rating for this service was inspected but not rated (published 4 September 2020). This is the first inspection of this service under the new provider which can give a rating.

Why we inspected

We received concerns that suggested people received poor care. As a result we undertook a comprehensive inspection in order to investigate these concerns and be able to give the service a rating.

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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from inspected but not rated 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 information in all key questions of the report.

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 people receiving safe care and treatment, management oversight of the service and personalised care.

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.

Magnolia House Care Home is a care home providing personal and nursing care to up to 38 people. At the time of the inspection, 26 people were living at the service.

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

People received safe care and felt safe within the service. Staff we spoke with understood safeguarding procedures and felt confident their concerns would be listened to and followed up. Risk assessments were in place to manage risks within people’s lives.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out. Staffing levels were sufficient within the home, and people felt they could get the support they needed from staff promptly.

Medicines were stored and administered safely. Staff were supervised well and felt confident in their roles.

The service was clean, and staff understood infection control procedures and followed them.

Audits of the service were detailed and any issues found were addressed promptly. Staff felt well supported by the manager, and were motivated to provide good care to people.

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.

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 the service under the previous provider was GOOD published on 6 October 2018. The service has not been inspected before whilst under the current provider.

Why we inspected

We received concerns in relation to the management of infection control, use of personal protective equipment and lack of leadership within the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.

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.