Reach Magnolia

Reach Magnolia is a residential care home providing the regulated activity Accommodation for persons who require nursing or personal care to up to six people. The service provides support to people with a learning disability and autism. At the time of our inspection there were six people using the service.

Reach Magnolia accommodates four people in the main house and two people are accommodated in the annex at the rear of the property.

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

Relatives had mixed feedback on the service. Some relatives told us the care had improved under the new registered manager with better access to activities, and they had tried hard to recruit new staff into the vacant positions. Other relatives felt improvements were still necessary to enable their family member to have the required level of supervision and support from a more consistent and suitably trained staff team.

Safe medicine practices were not promoted and risks to people were not identified and mitigated. Alongside this, some staff practice did not mitigate infection control risks.

The required staffing levels were not always provided which impacted on the level of supervision and support people received, including community access. Staff were inducted, but not suitably trained and supervised in their roles to benefit people.

Records were not accurate and suitably maintained. Auditing was taking place. However, this was not carried out in line with the provider's procedure and failed to identify the shortfalls we found.

Systems were in place to safely recruit staff. However, staff recruitment files did not contain evidence of actions taken in respect of chasing references or fully mitigate risks around any potential convictions. We have made a recommendation to address this.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Model of Care and setting that maximises people’s choice, control and independence. People were not supported to have maximum choice and control of their lives and staff did not 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.

Right Care: The provider was committed to promoting people’s dignity, privacy and human rights. They had identified a dignity champion and a dignity tree was on display which outlined how this was achieved. However, we observed during the inspection terms of endearment was used when engaging with people, a person was referred to as a “Good boy” and another person was told to “Chop, chop” when being supported to leave the service. These interactions did not promote people’s dignity and human rights.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. The provider was proactive in promoting a positive culture within the service. Poor practice was addressed, and some staff had specific training provided to further improve their practice and interactions with people.

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 6 June 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

In response to a review of the information we held about this service, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, medicine practices, staffing, the application of the Mental Capacity Act 2005 and good governance.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Magnolia is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Magnolia care home accommodates four people in the main house and two people are accommodated in the annex at the rear of the property. The service is registered for six people with a learning disability, mental health and other associated conditions. At the time of this inspection five people lived there.

This was the first inspection of the service since it was registered in November 2016. This was a comprehensive inspection to provide a rating for the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was no registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The home had a manager who was in the process of applying to the Commission to be registered.

At this inspection we found the service was providing safe, effective, caring and responsive care in a service that was led-led. Relatives were happy with the care provided. They gave examples where their family member’s independence had increased and their health and well-being had improved.

People were safeguarded from potential abuse. Risks to them were identified and measures put in place to mitigate risks. Accident and incidents were appropriately managed, recorded and measures put in place to prevent reoccurrence.

Staff were suitably recruited, inducted, trained and supported. They were clear of their roles and responsibilities and worked well as part of team. They were welcoming, kind and caring in their interactions with people and responded to changes in individuals in a timely and supportive manner.

Systems were in place to promote safe medicine practices. People were supported to attend to their health needs and nutritional needs and risks were addressed.

The home was suitably maintained and the equipment provided was serviced and safe. Staff were trained in health and safety and infection control. However, some areas of the home were in need of a clean to prevent cross-infection.

People were assessed prior to admission and transitions into the service ran smoothly. Some people had care plans in place, whilst for two people, who were new to the home, their care plans were under development. Person-centred care was promoted and staff worked in a person-centred way in facilitating individual’s communication.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff worked to the principles of the Mental Capacity Act 2005 and promoted people’s involvement in their care, independence, choices and activities.

The provider had systems in place to audit the service and get feedback to improve practice. The manager was new to the service. They had an action plan in place which identified improvements they wanted to make. They were clear of their vision and values for the service and had brought about positive changes in the short time they had been in post. Systems were in place to promote communication with the team and external professionals. Staff, relatives and other professionals were complimentary of the manager and the way the service was run and managed.