Archived: Care Management Group - Magnolia Cottage

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, inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Staff understood how to safeguard and protect people from abuse.

Individual risk assessments were in place with guidance for staff on how to manage risks when supporting people.

People received their medicines as they were prescribed. There were safe protocols for the receipt, storage, administration and disposal of medicines.

The service had systems in place to enable the service to learn when things went wrong to prevent incidents happening in the future.

People’s needs were holistically assessed and detailed in care plans. Care plans enabled staff to provide person-centred support and respond to people’s needs.

Staff received the training they needed to support people and were competent to carry out their role.

Staff understood people’s needs around eating and drinking and supported them in a way that also encouraged independence.

Staff worked well with healthcare professionals to make sure that people received the specialist support they needed.

The premises were adapted appropriately to people’s needs and people were consulted on the decoration.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Staff were kind and caring and treated people with compassion.

People were encouraged to be involved in the service through regular resident meetings.

Staff promoted people’s independence, often by encouraging them to do small parts of a more complex tasks if people could not manage the whole of a task.

Peoples preferences, likes and dislikes were clearly documented, and staff used pictures to enable people to communicate their preferences in order to respond to their needs.

Relatives and staff were positive about the management of the service.

There was an open and supportive culture that promoted learning and improvement.

People using the service were engaged in a way that was appropriate to their communication needs.

The service made links to support people to be involved in their local community.

Rating at last inspection: At the last inspection the service was rated good (report published 15 December 2016).

Why we inspected: This was a planned comprehensive inspection based on the rating at the last inspection.

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

Magnolia Cottage provides a home and support for a maximum of four people with a learning disability. The home is a bungalow in keeping with others in the local community. At the time of our inspection, there were four people using the service.

There was a registered manager in post. 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 2008 and associated Regulations about how the service is run.

Staff promoted people's safety. They understood their obligations to report any concerns or suspicions that people were at risk of harm or abuse. There were enough staff to meet people's needs and they were recruited in a way that contributed to protecting people from the employment of staff who were unsuitable to work in care.

Risks to people's safety and welfare were assessed with guidance for staff about managing these. Staff knew how to respond if there was a fire or an accident in the home so that people's safety was promoted. The registered manager kept the safety of the service under review. This included ensuring that staff managed medicines safely.

The level of staff turnover raised potential problems for people living in the service. The management team and relatives recognised that people needed support from consistent staff. There were some staff who had developed a good insight into people's specific individuals needs and how they communicated. However, there were many new staff who needed to develop their skills and knowledge to support people with complex needs.

The registered manager and regional director identified the need for additional support, coaching and training for staff. They had recognised the need to improve written guidance about people's care in order to support staff, particularly new staff members, to understand and meet individual needs. They had put plans in place to achieve this.

Staff were aware that any action they took to ensure people's safety and welfare should not restrict them unreasonably. Longer standing staff members understood how people communicated their consent to receiving care. They involved family members who knew people well to help participate in planning how people's needs could be met. However, staff were not consistently clear how people's capacity to make specific, individual decisions about their treatment should be looked at.

People received support to eat and drink enough to keep them well and healthy. Staff ensured they sought guidance from professionals and acted on advice from them to promote people's physical and mental wellbeing. They understood the signs that people might show if they were becoming unwell or in pain so that they could respond promptly.

Staff treated people warmly and with regard to their dignity, privacy and independence. They took action to intervene if people were upset, anxious or distressed and understood how people might express this.

There had been a period of inconsistent leadership within the service, which had affected the morale and motivation of staff. This contributed to a lack of clarity about staff roles and accountability. The new registered manager had been in post for only five weeks at the point of this inspection, but was already making improvements to the quality of care people received, how staff were supported and listened to, and how the views of relatives were considered. They had identified with the regional director, priorities for further improvement and established clear systems for checking and monitoring the service.

There were picture menus so that people could make choices about what they wanted to eat. One person showed us this and said they had baked beans for their breakfast. People were able to access drinks freely. The fridge and cupboards were well stocked, including with fresh fruit and vegetables. Staff checked people's weights so that any concerns about nutrition could be followed up.

The home was kept clean so that risks of infection were minimised. Staff had training to help to do this. The home was also free from unpleasant smells.

We found that staff had access to training and that this was kept up to date so that they were competent and effective in their roles. We also noted that proper checks were carried out before staff started work, to ensure they did not present a risk to vulnerable people. There was a 'checklist' within staff files to ensure that the process was completed properly. We know from other services in this group that the provider had robust systems for checking that staff were properly recruited and training was kept up to date.

People interacted well with staff. They were encouraged to do things such as making drinks, for themselves with staff support and prompting if necessary. Staff offered people praise and encouragement to do things and also acted promptly to distract people when they saw they were becoming anxious or agitated. We concluded from this that the staff on duty understood people's complex needs and that they followed guidance in people's plans of care.

One person told us they liked being in the home and who they would speak to if they had any concerns. They had made their own complaints booklet with support, showing who they could speak to and what to expect if they did complain.

Most people had regular contact with family members and we saw comments from relatives showing they were happy with the service people received.