Magdalen Close Hostel

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. People received an assessment when they joined the service, to support the development of a care plan. Leaders also ensured there was a dedicated keyworker allocated for each person. However, whilst we found care plans were being reviewed monthly, they were not always accurate, comprehensive or fully up to date to reflect people’s changing needs. Additionally, people’s involvement was not always clear. This meant the service could not reliably show that assessments reflected people’s current strengths, preferences or support needs. Staff told us they relied on their own knowledge and experience of people’s care needs and could clearly explain how they knew about changes for people which had taken place. Despite these gaps, people told us staff understood them in practice. A person said, “Staff help me.” A relative told us, “[Person] is very particular. Luckily, staff know [person] really well. They know exactly what [person] likes and what [person] doesn’t like.” The registered manager recognised assessments needed improvement and confirmed care plans would be reviewed as they transitioned onto electronic records.

The provider planned and delivered people’s care and treatment, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards, although some areas required strengthening to ensure consistency. People received care aligned to recognised good practice in many areas. Speech and language therapy (SALT) guidance was in place for several people, including specific instructions around food preparation and support at mealtimes, although this needed to be more consistently set out throughout all care records. Staff demonstrated an understanding of people’s healthcare conditions, and we saw positive examples of adjustments, such as supporting people with sensory needs or offering dietary supplements to promote healthy weight gain. A staff member said, “We are pretty good with our 5-a-day,” and “[Person] had lost some weight, but [person] is slowly putting it back on, having the build-up shakes.” We received positive feedback about meals. A relative said, “There’s veg and fruit and salad. It’s healthy.” People were involved with choosing menus and cooking, with some people attending college courses to support this aim. A person told us they like to cook, including, “Curry, Thai food, and lasagne.” Another person had peeled the potatoes for lunch on the day of our visit.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services. Staff across different houses described good working relationships and a willingness to support each other, including with changes at the service. A staff member said, “We all help each other.” We saw examples of positive multidisciplinary input. Professionals engaged in reviews, and staff worked closely with relatives, social workers and health services. For example, staff liaised with therapists about people’s sensory and communication needs and accompanied people to health appointments. A professional who worked with the service told us, “Throughout my involvement with Magdalen Close Hostel, communication has consistently been clear, timely, and professional. The staff and management team have always been approachable, supportive, and willing to engage.” This led to positive outcomes in day-to-day support.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support. People were supported to take part in activities that promoted healthy lifestyles, such as walks in nature, going to clubs, and using shared garden spaces. This included an on-site allotment for people to grow their own fruits and vegetables. A relative said, “They do a lot of walking. It’s so good to get the fresh air.” A staff member told us, “We have some small exercise groups anyone can access. In our house, we try to take [people] out in the vehicle. We do beach walks, parks, it’s been a bit colder, so we have not been out as much, but they do enjoy it.” Staff were observant in identifying any signs of illness, including for people who do not communicate verbally with words. This meant healthcare support could be promptly sought. A staff member added, “We knew [person’s presentation] wasn’t right, so we took them straight to 111 and [person] seems to be much better now.” Relatives told us they felt staff kept people healthy. One relative said, “[Staff] take [person] to the doctors and so on. Otherwise, I take [person] for blood tests and a medical,” and, “[Staff] would tell me when [person] is due for a vaccination and give me a choice, whether I take [person] or them.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent. Whilst people’s health-related treatment was monitored to check it was effective, such as the impact of nutritional supplements on weight gain, there was less emphasis on the monitoring of people’s wellbeing or quality of life outcomes. Leaders did not carry out any formal auditing or checks of daily care notes, which were being completed both on paper and online during the transition to new electronic systems. This made it more difficult for staff and leaders to triangulate information and increased the potential for user error or omission. We received feedback that the use of 2 recording systems created duplication and reduced the effectiveness of information sharing. One staff member said, “We are still doing the written books, we are not sure when that’s going to stop.” This meant the service could not demonstrate how people’s outcomes were systematically tracked or used to drive improvement in their care. The registered manager was open to our feedback in this area and planned to address this as part of the digital transformation work already in progress.

The provider did not ensure systems were in place to always tell people about their rights around consent. Despite this, staff respected people’s rights when delivering care and treatment, and observations and feedback showed staff offered people choice and control. Decision-specific Mental Capacity Assessments (MCAs) were carried out if people could not consent to all aspects of their own care and treatment. However, some MCAs had not been fully reviewed for over a year. Many were seen to have been completed on the same day, which did not give people with a learning disability additional processing time to think about decisions and be fully involved in the process. Although records required review, we saw staff offering choice in practice. One staff member explained how they gave a person multiple options to pick from at mealtime. Relatives also confirmed staff respected people’s decisions, telling us, “It’s very person-centred. There’s always choice.” People had access to advocacy support to help them make more significant decisions, such as moving into a new home. Some people were under Deprivation of Liberty Safeguards (DoLS), which sets out a legal framework to protect them if they are subject to any restrictions, for example to ensure their safety. Whilst the registered manager had applied for DoLS appropriately, no statutory notifications had been submitted to the CQC as required. The registered manager completed this straight away when raised by inspectors.