Archived: The Magnolia Care Home

At our last inspection in January 2018 we rated the service overall as ‘Requires Improvement’. At this inspection the service had improved to ‘Good.’

The home provides nursing and personal care and accommodation for older people, people with disabilities, people living with dementia, people with mental health needs, people detained under the Mental Health Act and people with sensory impairments.

A registered manager was not in post. This is a condition of the registration of the service. A registered manager is a person who has registered with the Care Quality Commission 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 and associated Regulations about how the service is run. We will monitor this to ensure a registered manager is recruited.

People's risk assessments provided staff with information on how to support people safely. Lessons to prevent incidents occurring had been learnt from past events. Staffing levels were sufficient to ensure people's safety.

Staff had been trained in safeguarding (protecting people from abuse) and, in the main understood their responsibilities in this area. Staff were subject to checks to ensure they were appropriate to work with the people who used the service. People were protected from the risks of infection.

People using the service and the relatives we spoke with said they thought the home was safe. They told us medicines were given safely to them. We found this to be the case.

Staff had been trained to ensure they had the skills and knowledge to meet people's needs. Staff understood their main responsibility under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives and they were of their responsibilities under this law.

People had plenty to eat and drink though not everybody thought food was of a high standard or variety.

People's health care needs had been protected by referrals to health care professionals when necessary. Visiting health professionals said that staff ensured that the standard of health care provided to people was good.

People told us they liked the staff and got on well with them. We saw many examples of staff working with people in a friendly and caring way, though there was one occasion where staff had not shown respect for a person which the manager followed up. People and their representatives had not all been involved in making decisions about their care, treatment and support.

Care plans were individual to the people and covered their health and social care needs. Activities were organised to provide stimulation for people though they had been limited.

People and relatives told us they were confident that if they had any concerns these would be followed up.

People, relatives and staff were satisfied with how the home was run by the manager. Management carried out audits and checks to ensure the home was running properly to meet people's needs and provide a quality service.

The service cooperated well with other healthcare professionals. They shared information with relevant organisations to develop and deliver joined up care.

The manager was aware of the need to report certain incidents, such as alleged abuse or serious injuries, to the Care Quality Commission (CQC), and had systems in place to do so should they arise.

The provider had a legal requirement to inform the public of the home's rating and had informed the public on their website of the rating of the home; the rating was also displayed in the home. The provider had also met its legal requirements by sending us notifications about events which happened at the home.

The inspection took place on 29 and 31 January 2018. The first day of the inspection was unannounced.

At our last inspection we identified a regulatory breaches related to safe care and treatment and good governance. At this inspection we found the registered provider had made sufficient improvements in these areas.

A registered manager was in post. This is a condition of the registration of the service. A registered manager is a person who has registered with the Care Quality Commission 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 and associated Regulations about how the service is run.

People and their relatives told us they were safe living at this service.

People's risk assessments provided staff with information on how to support people safely, though some assessments were not fully in place. People were not fully protected from the risks of infection.

Medicines were managed safely and people told us they had received their medicines.

Staff had been trained in safeguarding (protecting people from abuse) and, in the main, understood their responsibilities in this area, though staff needed more training in which relevant outside agencies to contact.

People told us they liked the staff and got on well with them. We saw many examples of staff working with people in a friendly and caring way.

People, their relatives and staff were satisfied with how the home was run by the registered manager.

Management had carried out audits and checks to ensure the home was running properly to meet people's needs though some essential had not been audited.

At our last inspection in April 2017 the service was not meeting regulations with regard to providing safe care and having systems in place to ensure quality services. We followed up these issues and found some improvements had been made, though further improvements were needed to staff practice, lessening risk to people’s safety, having sufficient staffing levels to keep people safe at all times, safe staff recruitment practices, supplying medicines and ensuring people were always supplied with a safe quality service.

At this inspection we found the service to be in breach of Regulations 12, Safe Care and treatment and Regulation 17, Good Governance, of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this 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.

The Magnolia Care Home provides personal and nursing care and accommodation for up to 38 people. On the day of the inspection the manager informed us that 28 people were living at the home.

A registered manager was in place at the time of this inspection visit but was not managing the service on a day-to-day basis. Another manager had been recruited who provided evidence that she had applied to CQC to become the registered manager in the near future. A registered manager is a person who has registered with the Care Quality Commission 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 and associated Regulations about how the service is run.

People's risk assessments did now always include the information staff needed to ensure people received safe care.

Safe care had not always been provided to people. Staffing levels were not sufficient to ensure people were kept safe.

Medicines had not always been supplied to people as prescribed to help them to manage their health conditions.

All staff had not been subject to comprehensive checks to ensure they were safe and suitable to provide care to people who lived in the service.

People and their relatives were not fully satisfied with how the home was run by the management of the service. Feedback was not used to bring about improvements in the service.

Management had carried out audits and checks to try to ensure the home was meeting people’s needs, though this system was not effective or robust to ensure that people using the service had their needs met.

People using the service and their relatives said they thought the home was safe. Staff had been trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area.

Systems to ensure that the premises were safe for people to live in were, in the main, in place.

People and their relatives told us that staff were, in the main, friendly and caring. We saw a number of examples of staff working with people in a kind and respectful way.

This inspection took place on 19 and 20 April 2017. The inspection was unannounced and was carried out by one inspector, a specialist adviser and an expert by experience. A specialist adviser is a person who has expertise of the client group of the service. The specialist adviser was a qualified nurse who had expertise of nursing care. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Our expert for this inspection had experience of the care of older people and older people living with dementia.

At our last inspection in February 2016 the service was not meeting the regulation we inspected with regard to keeping people safe . We followed up these issues and found some improvements had been made, though further improvements were needed to ensure people were supplied with a comprehensive service.

A registered manager was not in place. The previous registered managers had left their employment shortly before the inspection. The acting manager stated that she had applied to be the registered manager. A registered manager is a person who has registered with the Care Quality Commission 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 and associated Regulations about how the service is run.

People using the service and their representatives we spoke with said they thought the home was safe. Staff had been trained in safeguarding (protecting people from abuse) and generally understood their responsibilities in this area.

People's risk assessments have not always been comprehensively followed to ensure people received safe personal care.

Staffing levels were not fully sufficient to ensure people were safe at all times.

People using the service told us they thought medicines were given safely and on time. We found in the main, medicines had been supplied to people as prescribed.

Staff had not been subject to comprehensive checks to ensure they were appropriate to provide care to people who lived in the home.

Management had not carried out comprehensive audits and checks to ensure the home was running properly to meet people's needs.

We found breaches of regulations in respect of ensuring the safety of people using the service, and not having quality assurance systems in place to ensure the effective running of the service. We will closely monitor the service and take more robust regulatory action if the service does not improve.

Systems to ensure that the premises were safe for people to live in were in place.

Most staff had been trained to ensure they had the skills and knowledge to meet people's needs. However, more training was needed on relevant issues to ensure staff were trained in the required areas in order there was assurance they could meet all the needs of people.

Staff generally understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives, and the service had obtained legal approval for limiting people's choices when necessary for their best interests.

People had, in the main, plenty to eat and drink, most people told us they liked the food served, though some people wanted more choice and variety. People had been assisted to eat when they needed help.

People's health care needs had been, in the main, protected by referral to health care professionals when necessary.

Evidence was found not in place that people and their relatives were involved in making decisions about their care, treatment and support, though evidence was lacking in some care plans.

Care plans were not comprehensively individual to the people using the service to cover all their health and social care needs.

There were not sufficient numbers of staff to ensure that people's needs were responded to in good time.

Activities were organised to provide stimulation for people, though activities tailored to people's needs had not been frequently provided.

People and relatives told us they would tell staff if they had any concerns and were confident they would be followed up to meet people's needs.

People, their relatives and staff were generally satisfied with how the home was run by the manager.

People and their relatives told us that staff were friendly and caring and we saw many examples of staff working with people in a kind and compassionate way.

This inspection took place on 15 and 16 February 2016. The inspection was unannounced and was carried out by two inspectors and an expert by experience.

Two registered managers were in place. A registered manager is a person who has registered with the Care Quality Commission 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 and associated Regulations about how the service is run. The registered manager responsible for nursing was managing the service at the time of the inspection.

We carried out an unannounced inspection of this service on 19 January 2015. Two breaches of legal requirements were found. The provider had not ensured that people were protected against the risks of unsafe care being provided by unsuitable staff, had not supported staff with adequate training to meet people's needs. After this inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We checked that the provider had followed their plan, and to confirm whether they had now met legal requirements. We found improvements in some aspects but not all issues had been properly followed up.

Since the last inspection we had received information from whistle-blowers which had stated that medication was not properly dealt with and that people receiving the

service were always dealt with in a polite manner. We followed up these issues at this inspection. We found that people were mainly respectfully dealt with and there was evidence that people had received their medicines.

On this inspection we found a breach of the Health and Social Care Act 2008 Regulated Activities Regulations 2014 with regarding to providing safe care. You can see what action we have told the provided to take on the back of the full version of this report.

People using the service and the relatives we spoke with said they thought the home was safe. Staff had been trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area.

People's risk assessments did not always provide staff with information of how to support people safely.

There were insufficient numbers of staff to ensure that people were protected from incidence of behaviour that challenged the service.

Staff used appropriate moving and handling techniques to safely transfer people.

People using the service and a relative told us they thought medicines were given safely and on time. Some improvements were needed to the way medicines were recorded to evidence that medicines were properly supplied to people.

The premises appeared safe with no tripping hazards observed.

Agency staff were not subject to rigorous checks to ensure they were appropriate to work with the people who used the service.

Staff had been trained to ensure they had the skills and knowledge to be able to fully meet people's needs.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives, and the service had obtained legal approval for limiting people's choices when necessary for their best interests.

People had plenty to eat and drink, everyone told us they liked the food served and people were assisted to eat when they needed help.

People's health care needs had usually been protected by referral to health care professionals when necessary.

People and relatives we spoke with told us they liked the staff and got on well with them, and we saw many examples of staff working with people in a friendly and caring way, though there were some incidents of not treating people with respect.

People and their representatives were involved in making decisions about their care, treatment and support.

Care plans were individual to the people using the service and usually covered their health and social care needs.

Activities were not always provided to meet people's needs.

People and relatives told us they would tell staff if they had any concerns and were confident they would be followed up to meet people's needs.

People, relatives, staff and professionals were satisfied with how the home was run by the registered managers.

Management carried out audits and checks to ensure the home was running properly to meet people's needs, though these needed to be more rigorous to provide comprehensive checks.

We observed a nurse administering medicines during the morning and also again at lunchtime. They explained how they administered medicines in order to check that the correct medicine was given. We observed that the nurse was kind, caring and patient allowing people time to take their medicines.

The service had regular support from health care professionals. We found that people's medicines were reviewed and changes made when necessary. One member of staff told us: 'We always ensure people have their medicines reviewed. A doctor is here today reviewing people and their medicines'. This showed that the service had support from a professional healthcare team to ensure people were given medicines based on their current needs and lifestyle.

The supplying pharmacy supported the service and provided advice on safe medicine management. We were shown a copy of a medication audit dated 26 September 2013 which the supplying pharmacy had undertaken. The audit detailed areas that required further improvement, in particular record keeping and ensuring medicines were stored at the correct temperature. We found that, although some action had been taken, further improvements were necessary to ensure medicines were handled and stored safely.

We spoke with six people who used the service during our inspection and the relatives of three people who used the service. We talked with 15 members of staff working at the service, both on the night shift and on the day shift. We also spoke with the provider.

People who used the service were generally happy with the care they received at the home. One person told us: "I get help as needed. The staff do vary a bit and some carers are better than others in how they treat you, but things have been better over recent weeks with the new management. I would say that life in the home is dependent on the staff on duty." Some of the people we spoke with told us there was a lack of stimulation and activity within the home and that they rarely got taken out. One person said: "'There's very little to do, I sometimes play dominoes with the staff but not all of them can or will play. I miss conversation about the news and day to day things. We don't get opportunities to go out."

Staff we spoke with were positive about how things at the home had improved. They reported to us that they now had time to deliver quality care and complete any necessary paperwork. They told us this was due to increased numbers of staff on duty during each shift.

As part of our two day inspection on this service we spoke with 15 staff members, including the proprietor and the registered manager. We spoke with 11 people who used the service, the relative of someone who used the service and two visiting professionals who were visiting the home at the time of our inspection.

Some of the people who used the service were not able to speak with us due to their conditions. However, two people were able to describe the care and treatment they received at the home. One person expressed concern that they did not know what their plan of care was. They told us: "I have never had a discussion about my care. I would love to sit down with someone and discuss what I would like'. Another person who had fallen from their wheelchair asked us not to alert staff. They commented: "Please do not tell anyone. The staff tell me I am a nuisance'.

We spoke with staff. All of the care workers and registered nurses who we spoke with told us that there were not enough staff on duty to meet people's needs. Staff told us that they did feel supported but expressed concern about levels of care due to a lack of staff.

People using the service were generally happy living at the home. They told us that the staff worked hard to look after them and they felt that their needs were being met. One person told us: "The staff are very good. Nobody's ever left." One person we spoke with felt there was a lack of activities for people using the service.

Staff we spoke with told us they felt that the management at the home were approachable and told us that they could raise any issues should they need to. Some of the staff we spoke with told us that they did not feel supported in relation to training as they were sometimes expected to do this in their own time. Staff felt they were adequately trained to carry out their roles. Staff all told us that they enjoyed working at the home.

We found that care had been adequately assessed and planned and that people's needs were being met by staff who were adequately trained. There was a complaints procedure in place to assist people in making complaints should they wish to. We concluded that staff were not being adequately supported in relation to training and that improvements were needed in relation to how consent to care was being obtained.