Magnolia House

Updated 8 September 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was conducted by 1 inspector and an Expert by Experience on the first day and 1 inspector on the second day. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Magnolia House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Magnolia House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

Both days of this inspection were unannounced.

Inspection activity started on 12 May 2023 and ended on 2 June 2023. We visited the service on 12 and 16 May 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection, including the statutory notifications we had received from the provider. Statutory notifications are reports about changes, events or incidents the provider is legally obliged to send to us. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 6 people who used the service and 4 relatives about their experience of the care provided. We reviewed a range of records. This included 12 people's care records and 6 people’s medicines records. We looked at 3 staff files in relation to recruitment and induction. A variety of records relating to the management of the service, including accident and incident records, safeguarding and policies and procedures were reviewed.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with 9 staff members including the provider, the provider’s senior manager, the registered manager, the deputy manager, and care staff. We spoke to and/or received written feedback from 6 external professionals.

Updated 8 September 2023

About the service

Magnolia House is a residential care home providing personal care for up to 40 people. The care home accommodates people within one large, adapted building, with access to floors by lifts or staircases. The service provides support to older people whose needs included physical needs and dementia. At the time of our inspection there were 29 people using the service.

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

Whilst people and their relatives told us they felt safe in the service, we found risks to people were not safely managed. Risks had not always been assessed or monitored and staff did not have guidance to effectively reduce those risks. Care plans and risk assessments did not identify essential information to ensure people were supported in a safe way.

People were not receiving safe care. For example, staff did not have sufficient information to be able to ensure they understood how to manage risks to people from pressure injuries, choking risks, falls, specific health conditions and behaviours that posed a risk to others.

People were not 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 support this practice.

Staff had not all received up to date training in safeguarding. Although they were able to describe actions they would take if they suspected or witnessed any abuse, we found not all safeguarding incidents had been acted upon. This meant people had continued to be at risk of harm.

There was a process in place for incidents and accidents to be recorded. However, records we reviewed were not always fully completed and had not been reviewed by the management team. This was important to ensure action could be taken to address issues when needed and prevent a reoccurrence.

Not all staff had received appropriate training to ensure they had the skills and knowledge to effectively support people. Staff had not had regular supervision to ensure they were helped to develop their skills and supported in their role.

Staff response times to people using their call bells for assistance were very poor. The management team had not carried out audits of the call bell system, which would have enabled them to identify where improvements were needed. This meant we were not assured people received support in a timely way.

People were not always treated with dignity and respect and staff were task focussed. We observed staff interactions with people using our short observational framework. This showed although some staff spoke to people with kindness and were caring, those people who were unable to easily hold conversations did not receive meaningful engagement from staff.

People received enough to eat and drink and told us they enjoyed the food. However, information was not clearly recorded when people needed a modified diet or were at risk of choking.

People were supported to access healthcare services when required. However, information relating to people's health needs was not always clearly documented within people's care plans.

Most people and their relatives told us they understood how to complain and would feel comfortable to do so. However, the leadership of the service was poor with limited management oversight. Quality and safety monitoring systems were not robust. This meant the provider and registered manager could not be proactive in identifying issues and concerns in a timely way and acting on these.

Governance processes and systems in place to help ensure the safe running of the service had not identified all the concerns we found. CQC had not been notified of significant events as required. This led to missed opportunities for ensuring the quality of care people received was of a good standard and safe.

Recruitment processes were safe to ensure only suitable people were employed. The service was clean and infection control measures were in place. People’s medicines were managed and administered safely.

People and relatives felt staff were kind and welcoming. We observed staff speaking to people with kindness.

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 30 September 2017).

Why we inspected

The inspection was prompted in part due to concerns received about how the service assessed and met people’s needs and managed risks. A decision was made for us to inspect and examine those risks.

In addition, the inspection was prompted in part by notifications of two incidents following which, 1 person using the service died and another came to serious harm. These incidents are subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of these incidents. However, the information shared with CQC about these incidents indicated potential concerns about the management of risk of falls and monitoring in place and the management of behaviours that pose a risk to others. This inspection examined those risks.

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 overall rating for the service has changed from good to inadequate based on the findings of this inspection.

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

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

Enforcement

We have identified breaches in relation to risk management, staffing, consent, dignity, governance and failing to notify the commission of significant events, 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

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.