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.

This is the first assessment for this service since registration under the new provider. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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.

Safety events such as accidents and incidents were recorded, investigated and responded to appropriately to prevent reoccurrence and mitigate future risk. Following incidents consideration was given to why these may have occurred and what may be done to reduce repeat events. For example, for people who were at a high risk of falls, alternative equipment such as alert mats had been considered and implemented where appropriate.

Key information, updates and actions were shared with staff, including any increased risks and changes in needs and priorities in staff handovers and through electronic records. This helped ensure staff had the information they needed to deliver safe and effective care.

Managers carried out a range of audits to monitor standards. They identified actions and communicated these across the team to address issues and drive improvement. Staff and relatives confirmed they were kept fully updated of changes in relation to people’s needs.

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.

The management team carried out assessments before people moved to the home to ensure their needs could be met. This included gathering information from people, their families and health and social care professionals, where required. This supported a smooth transition between services and helped people settle into the service.

People and relatives confirmed they had access to GP services, specialist nurses, dentists and opticians where required. On review of peoples care records we found evidence that people received this additional support as needed.

People’s care records included a hospital pack containing relevant information if a person needed to be admitted to hospital or transferred to another service, this helped to ensure continuity of care.

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.

People and their relatives told us they felt they or their loved ones were safe living at Magnolia House. Comments included, "I am settled in my mind that he is safe and well looked after" and “I am 100% happy with where they are, and they are safe." A person also told us, they were, “very safe.”

There were processes and systems in place to help ensure where safeguarding concerns were identified, these would be investigated and acted on in a timely way. Most staff had received training in safeguarding, and all staff we spoke with were able to describe types of abuse and what action to take if they had any concerns. There was a safeguarding and whistleblowing policy in place which gave staff clear guidance to follow in the event they needed to refer any concerns to the local authority.

Mental Capacity Act (MCA) assessments, best interest decisions and Deprivation of Liberties Safeguard (DoLS) applications had been completed where required which meant we were assured staff protected people's human rights in line with the MCA. The management team kept a record of DoLS applications and authorisations, and this was regularly reviewed to make sure authorisations were current.

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.

People’s care records contained detailed risk assessments, which provided staff with clear and consistent information in relation to people’s specific risks and how best to keep them safe. These included risks relating to falls, medication, choking and skin integrity. Staff regularly reviewed people’s risk assessments and care plans to ensure they continued to reflect people’s needs and preferences. People or their relatives were involved in these reviews.

Risks to people were managed appropriately. For example, where people were assessed as being at risk of choking, care plans and risk assessments provided clear guidance on food and fluid consistencies, eating and drinking positions, levels of supervision required and actions staff should take in the event of a concern. Throughout our visits we saw people supported to eat and drink in line with their care plan and risk assessment.

Staff knew people well, and this helped to keep them safe. Training in subjects such as moving and handling, dementia awareness, food safety and skin health was available to staff to ensure they were able to safely meet people’s needs.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Some interior of the service was in need of refurbishment and did not always support people living with dementia, poor vision or mobility issues. For example, we found the garden area required attention, including safer walkways and more appropriate seating to ensure people using this area could do so safely. Additionally, there was limited distinction between some areas of the home and a lack of clear signage to support people to identify their environment. This was discussed with the management team who acknowledged they were aware of these issues and had plans in place to address this.

There were effective arrangements to monitor the safety of the premises and upkeep of equipment to ensure both people and staff were kept safe. There were appropriate environmental risk assessments when required, for example, in relation to fire safety. Regular safety audits were completed including for utilities and equipment. Where concerns were identified records of required actions and outcomes were maintained.

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.

People and relatives were positive about the staffing levels at the home. A person told us, “If I shout staff come straight over to help me.” Another person said, “I don’t go downstairs as I don’t want to, but staff regularly checked to make sure I’m okay.” A relative told us, "There are always lots of staff around to assist people. There is always someone available in the main lounge."

Throughout our assessment visits we observed staff were available to people as required and there was lots of positive engagement between people and staff. Staff also confirmed there had been a recent increase in staff numbers and this had a positive impact on the care they could provide and gave them increased opportunities to spend more time with people.

Staffing levels were discussed with the management team who confirmed these were determined by the number of people using the service and the level of care they required. Staffing levels were regularly reviewed to determine the numbers of staff provided remained sufficient to meet people's needs. Call bell audits were frequently completed to verify that people’s needs were met in a timely way.

Staff told us they received regular training which covered topics relevant to the service and staff specific roles, staff also demonstrated they had the skills to provide people with safe, effective and person-centred care. A formal process was in place to support staff with staff meetings, regular 1 to 1 and group supervisions, competency checks and annual appraisals.

We found appropriate recruitment checks were completed to reduce the risk of unsuitable staff being employed. The provider demonstrated they understood recruitment requirements.

The provider did not always safely manage the risk of infection. Some areas of the home and equipment were not appropriate or maintained to a standard that supported good infection control, which could impact on cleanliness and hygiene. For example, within the dining room there was signs of wear and tear of the flooring which was held by tape. This meant this area could not be effectively cleaned. This was discussed with the manager who confirmed they were aware of this issue and actions were planned to address this. This was further evidenced in the providers action plan.

Additionally, we observed in a person’s bedroom, a wooden commode which had fixed fabric covering the seat and back rest. This had dried stains on. This was discussed with the manager who agreed to arrange an immediate replacement.

The provider employed domestic staff to ensure appropriate standards of cleanliness throughout the home. With the exception of the issues raised above, we observed the home was clean, hygienic and odour free. A relative confirmed, “The home is always clean and tidy."

Most staff had infection, prevention and control training and could describe how they used this knowledge in practice to minimise infection risks. We saw personal protective equipment was readily available and used appropriately and consistently by staff.

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.

Medicines administration was recorded accurately on people’s medicines administration records, and medicines were stored safely and securely.

Processes were in place to support the safe and effective use of medicines. Staff had access to person-specific guidance for medicines prescribed on an ‘as required’ basis, which supported consistent and safe administration.

Medicines quantities and stock balances were regularly checked and found to be accurate. There were clear processes in place for recording and reviewing medicine-related incidents or errors. Staff responsible for administering medicines were appropriately trained and supported in their role.