Magdalen Close Hostel

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

The service was in breach of legal regulation in relation to dignity and respect.

This service scored 55 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity. However, staff did treat colleagues from other organisations with kindness and respect. Although many staff interactions were caring and warm, records did not always reflect a respectful, strengths based approach. For example, some documents did not show an understanding of how people expressed anxiety or distress, with entries labelling people as ‘lashing out’, being ‘rude’ or ‘impatient’. Staff also described people as ‘mischievous’, ‘in behaviours’, or as having ‘challenging behaviours’ without fully setting out what the person might be trying to communicate. This is not considered best practice when supporting people with a learning disability and or autistic people, as it describes the impact on staff, rather than proactively considering the feelings the person is experiencing. This had not been identified by leaders as a training need, to ensure all staff had the tools they needed to record care and support in line with best practice. The provider told us they would act on our feedback in this area. Despite these concerns, people and relatives frequently spoke about kind, caring relationships with staff. One relative told us, “Oh God, [person] loves them! They are so kind to [person]. [Person] hugs them. They speak so kindly to [person].” Another relative said, “[Staff] are all kind and caring.” More work was needed to ensure this consistently translated into record keeping and day-to-day staff practice, particularly during incidents of distress.

The provider treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s culture, backgrounds and protected characteristics. A staff member said, “[Person] is a loveable [gender of person].” and, “Comical and really cool.” Another staff member described a different person, telling us, “[Name] is such a lovely young [gender of person], who is so helpful.” People’s identities and achievements were recognised, and spaces were decorated to suit their preferences. One person showed us their bedroom, which was personalised to their taste, and full of pictures and photographs. A relative said, “[Person] has a lovely room, with everything they need.” We received feedback the service considered who would like to live together in the shared houses. A relative said, “They [people living in the house] all get on really well. They were matched. [Magdalen Close Hostel] considered that to suit them.” When asked about their housemates, 1 person said, “I get on with them all. They are my friends.” We saw people were supported to take part in events important to them. People were encouraged to carry out day-to-day activities like baking, shopping, household chores, and manage their own money as far as possible. Relatives told us they were satisfied with the care and support provided. For example, 1 relative said, “[Person] is so happy there. If you go you will see how lovely it is.” The registered manager confirmed they supported a diverse range of people, telling us, “It is not a 1 size fits all approach, they are all very individual.”

The provider sought to promote people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing. However, there was a lack of consistency in how this was applied in practice, with differences in meaningful leisure activity for people on and off site. We received feedback in some houses there was limited indoor activity. One relative said their family member, “Doesn’t seem to be doing much,” and “I would like [person] to do more indoors rather than sitting in their room watching TV. There seems no other option.” Another relative said, “[For person] to have more opportunity to do more day-to-day, would be an improvement.” The registered manager acknowledged this and had set up a new club for people to join on-site to encourage more varied leisure time. Whilst there were no visiting restrictions, people tended to spend time with relatives in a vacant house on site rather than their own homes, due to the size of shared spaces and potential impact on others. We received feedback this space could benefit from some work to make it more homely. Outside of the service, people were supported to make independent decisions in the community, take part in clubs, church and social events, and maintain routines important to them. One staff member told us about some local clubs people went to, telling us, “They meet with all their mates there.” Evidence also showed people gradually building skills to support their independence. A relative told us, “[Person] does their own washing now. [Staff] encourage [person’s] independence. I spoiled [person] at home.”

The provider sought to listen to and understand people’s needs, views and wishes. However, staff did not always record how they responded to people’s needs in the moment or act to minimise any discomfort, concern or distress. Staff were observed offering reassurance, including sitting with and calming a person when they became anxious. We also found staff could describe how they helped people feel calm and secure, such as engaging in activities like drawing, nail painting or walks. Care plans and daily records did not always reflect changes in health, mood or communication, and emotional support plans lacked detail about triggers or strategies. This lack of guidance meant several written entries in incident forms used judgmental or blaming language, such as describing a person as ‘quite violent’, ‘very disruptive’, ‘trying to wind up [their] peers’ or ‘hitting, pinching, spitting at staff for no reason’. This did not show empathy or understanding of unmet need. Other records showed a lack of clarity about how incidents were de-escalated, where a person was frustrated. The language used in records did not reflect our more positive observations, or feedback from relatives or staff. We raised this with leaders for review, to ensure written and verbal language consistently reflects compassionate practice, with staff supported to recognise how terminology, tone and recording styles impact people’s dignity.

The provider care about and promote the wellbeing of their staff. However, they did not always enable staff to deliver fully person-centred care. Care plans needed to be comprehensively updated, to ensure staff had all the personalised information required to carry out their role. Additionally, whilst leaders supported staff during and following incidents, there were no written de-briefs to demonstrate post-incident reflective practice and formalised wellbeing support. Despite this, staff consistently spoke about their emotional attachment to the people they supported and their enthusiasm for the role. One staff member said,“I love it here. I love my job.” Others described management as approachable, and flexible working was offered when needed. Staff retention was strong, and colleagues supported each other well in practice, creating a positive working culture. The provider told us after the inspection about some of the wider wellbeing initiatives available to staff, including paid time off for wellbeing and volunteering, free counselling, access to Mental Health First Aiders and the ability to join employee equality networks.