Reach Magnolia

Updated 30 November 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector on site over three days, with an Expert by Experience involved in making calls to relatives after the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Reach Magnolia is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Reach Magnolia is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection:

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We walked around the service to review the environment people lived in. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with the registered manager, operations manager, assistant operations director, deputy manager, a team leader and two support workers. We reviewed a number of records relating to individual's care and the running of the service. These included support plans for three people, medicine records for six people, three staff recruitment files, fire safety, health and safety, audits and staff competency assessments.

We asked the provider to send further documents after the inspection for review, which included policies, training matrix, supervision records, provider audits and meeting minutes. We spoke with five relatives, three support staff and sought feedback from professionals involved with the service.

Updated 30 November 2022

About the service

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.