About the service The Magnolia Care Home is a residential care home providing personal and nursing care to up to 38 people in one adapted building. At the time of the inspection there were 19 people using the service.
Since the last inspection the provider stopped providing nursing care and de-registered this regulated activity from their Care Quality Commission (CQC) registration.
People’s experience of using this service and what we found
A sustained period of management instability meant the pace of improvements since the last inspection was negatively impacted. A new manager started in June 2021 who was not yet registered with the CQC.
People remained at risk of receiving unsafe care. Not all fire safety risks had been fully addressed. Shortfalls in emergency evacuation documentation were found. The process for completing and updating risk assessments associated to people's care remained ineffective. An electronic care planning and recording system had recently been introduced and needed to embed into practice. Improvements to recording practices were ongoing.
There was no effective system to learn lessons when things went wrong. Improvements to incident and accident reporting and investigation processes were in progress.
Areas of poor practice were identified which meant people remained at risk of not receiving their medicines safely and as prescribed. Improvements were found in some aspects of medicines administration and recording.
Some improvements were found in quality assurance processes but continued shortfalls remained. The provider could not assure themselves effective systems were in place in all areas of the service. Oversight of the new electronic care planning and recording system was not fully established. Audit processes did not always pick on up issues to be addressed. A person centred and positive culture was not fully embedded among the staff team to support people achieve good outcomes.
Checks were in place prior to new staff starting work to ensure their suitability to work with vulnerable adults.
Good infection control practices were in place. There was sufficient supply of personal protective equipment (PPE) available including hand sanitiser, gloves, aprons and masks. Processes were in place to facilitate testing for COVID-19 and safe visiting arrangements.
Improvements had been made to people's care plans since our last inspection although gaps remained. All care plans were being rewritten and an action plan was in place to track progress. Staff knew people well and had good relationships with them. People were supported to maintain relationships with their relatives and friends.
Activities and opportunities to pursue interests were limited. Improvements were found in end of life care planning and recording.
Positive feedback was received about the new manager. They had the experience and knowledge to drive improvements in the service over time. People and relatives gave positive feedback about the care provided in the service. Staff felt supported by the provider and management team.
The provider and management team were supportive of the inspection process. The provider remained committed to making and sustaining improvements in the service. The management team were working closely with the local authority improvement team using an action plan to prioritise tasks and track progress.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was inadequate (published 12 March 2021) and there were multiple breaches of regulation. CQC issued warning notices for breaches of regulations 12 (safe care and treatment) and regulation 17 (good governance) and gave the provider a short timescale to make improvements. The service was placed in Special Measures.
At this inspection we found some improvements had been made but the provider was still in breach of regulations. The service will remain in Special Measures at this time because two of the Key Questions remains rated inadequate.
Why we inspected
We undertook this focused inspection to check whether the Warning Notices previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met, and also check whether the Requirement Notice in relation to Regulation 9 had been met.
This report only covers our findings in relation to the Key Questions of Safe, Responsive and Well-Led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained inadequate. This is based on the findings at this inspection.
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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Magnolia Care Home on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified continued breaches in relation to people receiving safe care and treatment and good governance arrangements in the service.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service remains 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 six 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.
This service has been in Special Measures since 11 March 2021. During this inspection the provider had not demonstrated that enough improvements have been made.
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.