CQC report explained · a residential care home
What the CQC found at Reach Magnolia
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risk assessments did not always identify or reduce risks, including choking, seizures, hot water and fire. Medicine instructions and records were also not always accurate.
- Effective?
- Requires improvement
- The home did not always follow the Mental Capacity Act when making decisions about care and treatment. Staff were not always suitably trained or supervised.
- Caring?
- Good
- This question was not inspected during this visit. Its previous rating was carried forward.
- Responsive?
- Good
- This question was not inspected during this visit. Its previous rating was carried forward.
- Well-led?
- Requires improvement
- Care and staffing records were contradictory, incomplete or difficult to read. Audits did not identify several of the problems found by inspectors.
What inspectors found, November 2022
Requires Improvement; inspectors found risks with medicines, staffing, consent and records, although there were signs of committed leadership and improving communication.
This was an unannounced focused inspection on 11, 12 and 17 October 2022. One inspector visited the home, an expert by experience called relatives, and the inspection team reviewed care plans, medicine records, recruitment files, audits and other documents. They also spoke with staff, relatives and health professionals.
The home was not always safe or effective. Risks such as choking, seizures, hot water and fire were not always properly assessed or managed. Medicine records and instructions were incomplete. Staffing levels did not always meet people's needs, which affected supervision and community activities. Staff training and support were also not consistently up to date.
The home did not always follow the Mental Capacity Act when making decisions for people who could not consent. Records were contradictory or incomplete, and audits had failed to find important problems. Inspectors found breaches relating to consent, safe care and treatment, staffing and good governance.
The overall rating changed from Good at the previous inspection to Requires Improvement. This means the service was not consistently meeting the expected standard and there was increased risk that people could be harmed. Caring and Responsive were not inspected during this visit, so their previous ratings were carried forward.
Health support
People had health action plans and access to health professionals. The home kept records of appointments and actions.
“People had health action plans in place which outlined the support required to meet their health needs.” from the report
Some safety systems
The home had systems for staff recruitment, fire checks, equipment checks and medicine storage. These systems were not always followed or effective, but some basic arrangements were in place.
“Medicines were suitably stored and at the recommended temperature.” from the report
Improving communication
Staff said communication and teamwork were good. Relatives generally felt communication with the home was improving.
“Communication is good, so we are kept up to date and we all work as a team and help each other out.” from the report
Willingness to improve
The registered manager responded to feedback during the inspection, and health professionals said the staff team was receptive to learning.
“The registered manager was committed to improving care for people. They took on board our feedback to bring about improvements.” from the report
Unmanaged risks
seriousRisks around eating, emergency seizure medicine, flammable cream, hot water and fire were not always identified or controlled. This could have put people at risk of harm.
“Risk management was not effective to promote safe care and treatment.” from the report
Medicine records and instructions
seriousSome 'as required' medicine protocols were missing or unclear. Records did not always show current medicines, medicines taken out of the home or medicines returned.
“Proper and safe management of medicines was not promoted.” from the report
Staffing and training
seriousThe planned number of daytime staff was not always provided. This affected supervision and people's access to community activities. Some required training and supervision were missing or overdue.
“Sufficient staff were not provided to meet people's needs.” from the report
Consent decisions
seriousMental capacity and best-interest decisions did not cover all relevant aspects of people's care, including vaccinations and medicine given for procedures.
“People were not consented with on all aspects of their care.” from the report
Poor records and audits
seriousCare records sometimes gave conflicting instructions and some changes were handwritten and difficult to read. Audits failed to identify problems with medicines, water temperatures and other records.
“Records were not suitably maintained, and effective systems were not in place to monitor the service and provide positive outcomes for people.” from the report
- 01What has changed in the eating and choking risk assessment, and how is staff practice checked now?
- 02How are 'as required' medicines authorised, recorded on medicine charts and checked when people return from social leave?
- 03How many staff are now provided on each shift, and how do you ensure people receive the supervision and community access set out in their plans?
- 04How are mental capacity and best-interest decisions recorded for vaccinations, medicines and other care choices?
- 05What checks now make sure care plans, rotas and medicine records are accurate and consistent?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 30 November 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, June 2018
Reach Magnolia was rated Good; inspectors found safe, kind and person-centred care, but some cleaning and care records needed improvement.
This was an unannounced, comprehensive inspection on 9 May 2018. Inspectors spoke with the manager and care staff, observed support, contacted relatives and health professionals, and checked care, medicine, staffing and recruitment records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, suitable training, safe medicines systems, kind interactions and support for people's choices, communication, health, activities and independence.
There were some areas to improve. Parts of the home needed a deep clean, two newer people did not yet have care plans, some daily records were incomplete, and one bathroom and shower room smelled damp. There was no registered manager at the time, although the manager was applying to register and had an improvement plan.
Staffing and safety
Inspectors found enough staff to support people safely, including when they chose to go out. Risks, accidents, fire safety and safeguarding were managed through recorded systems.
“During the inspection there was adequate levels of sufficiently trained staff to support people in the service.” from the report
Kind and respectful care
Staff generally built positive relationships and supported people in a calm, respectful way. Privacy, dignity, communication and independence were promoted.
“We observed staff interacting with people in an appropriate and caring manner.” from the report
Choice and independence
People were supported to choose meals, activities and aspects of their care. Inspectors saw people using communication aids and taking part in community activities.
“People were involved and consented with planning of their care.” from the report
Training and support
Staff had induction, specialist training, regular supervision and appraisals. The manager was working to develop the newer staff team.
“Since the new manager had been in post a system of regular monthly supervisions had been implemented and all staff had participated in an appraisal of their performance.” from the report
Positive management changes
The manager had introduced an action plan, clearer systems and audits. Staff, relatives and professionals gave positive feedback about how the service was run.
“The manager had brought about improvements to the service and had an action plan in place which outlined their priorities for the service.” from the report
Cleanliness
needs fixingSome areas needed a deep clean. Inspectors saw dust, cobwebs and dirt around the cookers and fridges, which could increase the risk of cross-infection.
“Areas of the home were in need of a deep clean.” from the report
Incomplete care plans
needs fixingTwo newer people did not yet have care plans or risk assessments. The manager said these were being developed and the provider was monitoring progress.
“Two people recently admitted to the home did not have care plans in place.” from the report
Incomplete daily records
minorInspectors found some gaps in daily records. The manager had included record keeping in the home's action plan.
“There were some gaps in recording of people's daily records” from the report
Damp smell
needs fixingA bathroom and one en-suite shower room had no windows and smelled damp. The manager agreed to ask maintenance to address this.
“The bathroom and one of the en-suite shower room had no windows and smelt damp.” from the report
No registered manager
minorThere was no registered manager in post during the inspection. The manager was applying to the Commission to become registered.
“There was no registered manager in post at the time of the inspection.” from the report
- 01Have the areas needing a deep clean, including around the cookers and fridges, now been cleaned and checked regularly?
- 02Were the care plans and risk assessments for the two newer people completed, and how quickly are new plans now put in place?
- 03What was done about the damp smell in the bathroom and en-suite shower room?
- 04What action was taken with the agency after inspectors saw a staff member taking little active interest in supporting people?
- 05Has the manager's application to become registered been completed?
This was the first comprehensive inspection since registration and covered all five quality areas, including the environment and care provided. This explanation was written from the published report of 7 June 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Reach Magnolia
2 rated inspections over 4 years: the service has slipped, from Good to Requires improvement.
- November 2022Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2018GoodSafe: GoodEffective: GoodWell-led: Good
- November 2016
Registered with the Care Quality Commission on 16 November 2016.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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