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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.

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.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

There were appropriate systems in place to learn as a staff team when things went wrong. There was a detailed analysis of incidents and accidents to identify any contributory factors, and any changes that needed to be made to reduce the risk of this happening again. After incidents there was a debrief with staff to explore what had happened, and these were reported to the local authority or CQC if appropriate. However, incidents at Magnolia House were rare and when they happened were discussed together as a staff team. Staff we spoke to were confident about how to report and incidents and how learning would be shared with them.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Leaders and staff worked collaboratively with wider health and care professionals to make sure people received care that was joined up and met their needs. People had health passports in place to support their transition between different services, and ensure all professionals involved in their care had the information they needed to support them safely and with compassion. There was clear guidance in place around how people should be supported, and at what point a referral to specialist teams might need to be made. For example, some people had a diagnosis of diabetes and had personalised guidance for how staff could recognise this was not being well controlled. Staff could confidently describe this and explained a recent example where they had identified concerns around a person’s diabetes and made an immediate referral.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff were trained and knowledgeable around their responsibilities to safeguard people from the risk of harm and abuse. Staff could clearly express how they might recognise this was happening and the action they would take as a result. One staff member told us, “I would speak to my manager first. But wouldn’t I hesitate in making a safeguarding referral if needed. I know where to find the form and phone number for the local authority”.

Where people were at greater risk of coming to harm, there were robust protocols in place of how staff would protect people which staff could confidently describe to us. Leaders ensured people were actively involved in the safeguarding process as equals. One stakeholder working with the service told us, “The manager has taken all steps possible to make safeguarding personal to the person we are working with. They made sure the process was accessible and safe to them, such as meeting in their home where they would feel more comfortable. They ensured we had all the information we needed to communicate with the person and involve them in the process fully”.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. Where the risks to people were deemed sufficient that restrictions such as living in locked accommodation were needed, to ensure their safety, appropriate authorisations were sought and recorded.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

There were clear and detailed risk assessments and care plans in place reduce the risks posed to people’s health and wellbeing. These were designed alongside people and regularly reviewed to ensure they were proving effective at promoting people’s quality of life.

Where people had reduced mobility, staff worked alongside them to ensure they had access to the equipment they needed. They had recently been working with one person to help them choose the equipment that they felt most comfortable with. Staff had clear guidance on how to help people mobilise safely and reduce the risk of falls, which enabled them to continue participating in the local community.

Staff could confidently describe how they would respond if a person was to have a seizure. Staff understood how to keep people safe, including at what point emergency services should be contacted. Seizures were recorded in detail to ensure staff could monitor any changes in people’s seizure activity such as these becoming more frequent and make appropriate referrals to understand the causes of this.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People lived in a vibrant and personalised environment, which included a large accessible garden space. There were regular checks to ensure risks posed to people were managed safely, and that the building remained maintained to a high standard. This included checks around fire safety, equipment being used and utilities including gas, water and electricity. We identified a small number of areas where further improvements could be made to ensure people’s safety. Appropriate and prompt action was taken by the provider once these were raised.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

There were sufficient numbers of staff employed who were knowledgeable and passionate about the people they supported. Appropriate recruitment processes were followed to ensure staff were suitable persons to support people, including use of Disclosure and Barring Service (DBS) checks which cross reference against police records. A DBS check is a criminal record check used by employers to help them make safer staffing decisions. Staff were trained in how to support people’s health and care needs safely including for example seizure management, and their ongoing knowledge and competency was regularly monitored. There was a system of supervisions and appraisals to monitor staff performance and wellbeing. The provider had a system to calculate the number of staff employed was sufficient to meet people’s needs. A recent inspection by the local fire and rescue service had identified additional staff were required to support people at night, and the provider took immediate action in response to this.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There was a high standard of cleanliness at Magnolia House, and regular checks to ensure that this was always the case. Staff had received training on how to protect people from the spread of diseases for example through appropriate hand hygiene and use of protective equipment.

Where possible, people were supported to be in control of managing the cleanliness of their environment. This included by supporting with the cleaning of their own rooms and doing their own laundry. Staff worked collaboratively with people to help them understand the importance of maintaining their own hygiene, and a result people had gained in independence and been supported to develop important life skills.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

There were robust systems in place to make sure people always received the medicines they needed, when they needed them. Staff had received appropriate training and their competency had been assessed to ensure they were able to safely administer medications. There were regular checks on medicine stocks to ensure people had access to the supplies they needed, and that these were being stored, administered and recorded in line with best practice guidance.

People were supported to have regular reviews of their medicines to ensure they remained appropriate. The service followed the principles of STOMP (Stopping over medication of people with a learning disability and autistic people). STOMP is a national programme focused on reducing inappropriate prescribing of antipsychotic medications to control behaviour and focuses holistically on people’s support needs and how they can be met through less restrictive means. We saw examples where the provider had worked closely with health partners to reduce people’s reliance on antipsychotic medications and embedded a holistic model of care.