Magna Nursing Home is a nursing home that provides care for up to 36 older people, many of whom are living with dementia. At the time of our inspection there were 27 people living in the home. At the last inspection, in August 2015, the service was rated Good. At this inspection we found that the service remained Good.

People and their relatives confirmed they received safe care. Staff were aware of the safeguarding policies and procedures and had received training in how to protect people from avoidable harm.

Staff recruitment was robust and prospective staff undertook appropriate checks prior to starting work at the service. Mostly there were enough staff to provide care and support to people to meet their needs. However some relatives felt that at certain times during the day, for example, during staff breaks there needed to be more staff available. Medicines were administered safely.

People were supported by staff who were knowledgeable about them and who had undertaken sufficient training to meet people’s needs. Staff received regular supervision and were encouraged to attend staff meetings. This ensured that staff could continue to provide effective care. People were supported to maintain good health and nutrition.

Staff were encouraged to develop positive relationships with people. People and their relatives described staff as caring and that they treated people with respect and kindness. People had detailed personalised plans of care in place to enable staff to provide consistent care and support in line with people’s personal preferences. Where we identified a care plan as being out of date the registered manager responded promptly to make the necessary changes.

People and relatives told us that they had no concerns or complaints about the service. They were aware of and had access to the registered provider’s complaints policy. They would speak to staff if they had any concerns.

The service had a positive ethos and an open culture. The registered manager was visible in the home which was appreciated by both people using the service and staff.

The registered manager used a range of methods to assess, monitor and improve the service. These included regular audits of the service and staff and service user meetings to seek the views of people about the quality of care being provided.

This inspection took place on the 2 June and was unannounced.

Magna Nursing Home accommodates up to 36 older people, some of whom are living with dementia. It is situated in Wigston on the outskirts of Leicester. The home is on two floors with a lift for access. It is close to local shops and amenities. At the time of the inspection there were 33 people using the service.

The home had a registered manager. This 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.

Relatives said they thought their family members were safe at the home and had peace of mind about them being there. Staff knew how to keep people safe and ensured they had the support they needed to live as safely and independently as possible.

Staff were trained to keep people safe and understood the signs of abuse and how to report any concerns they might have. People who lacked capacity to make certain decisions were effectively supported with staff using the least restrictive methods available.

There were enough staff on duty to meet people’s needs. Staff had the time to both support people and interact socially with them. Staff were safely recruited and the right skills and experience to provide safe care. Medicines were safely managed the home and given to people in the way they wanted them.

We observed lunch being served and saw this was a friendly social occasion where staff encouraged people to interact with them and with each other. Relatives praised the food served and said their family members enjoyed it. The menus we saw were varied and balanced and showed that people had choices at every meal.

People’s health care needs were identified and care plans put in place to assist staff in meeting them in conjunction with health care professionals where necessary. Relatives told us staff acted quickly if people using the service needed medical attention.

Relatives told us the staff were caring and kind and staff told us they would be happy for one of their own family members to be cared for at the home. We felt there was a happy caring atmosphere in the home and staff went out of their way to include people in activities.

Relatives told us the staff were always respectful to the people using the service and we observed this during our inspection. However some improvements were needed to the way records were written to ensure people’s photos were dignified and the appropriate language used when describing people’s mental health needs.

Relatives told us the staff provided personalised care that focused on the needs of the individuals.

Care plans instructed staff on how to support people in the way they wanted. All the staff we spoke with had a good understanding of people’s individual needs.

The home’s activities co-ordinator provided a range of group and one to one activities for the people using the service. During the inspection we observed people singing, doing art, having hair care and manicures, and playing board games. We saw that staff constantly encouraged people to remain active and get involved in the life of the home.

Relatives told us that if they had any concerns they would raise them as the home had an ‘open’ culture where it was easy to do that. Records showed that if someone did complain or raise a concern staff documented this and took action to put things right.

All the relatives we spoke with said they thought the home was well-led and homely. The atmosphere was warm and welcoming. The focus was on quality and life with the people using the services at the centre of how the home was run.

Relatives told us the registered manager was always friendly and approachable. Both the registered manager and deputy were knowledgeable about the people using the service and had a good understanding of their individual needs. The registered manager had systems in place to monitor and assess the overall quality of the service.

Some of the people who lived at the home had limited communication and we were unable to ask them about their experiences.

At our last inspection we found poor practice in the care of people with dementia and, following an incident in the home, evidence that a care plan was not fit for purpose. In addition nutrition was not being well managed, and some of the people who used the service had a poor experience of mealtimes.

Since then a new manager, Mrs Salome Mapfeka, has been appointed and has worked with the staff team to bring about improvements to the standard of care and nutrition. She has also consulted with the people who used the service and their families to help ensure they are getting the care they need. One relative told us “The new manager’s lovely. I could talk to her about anything.”

Relatives told us the home had changed for the better. One relative said, “It’s much better than when you first came, the new manager is licking the place into shape. She listens and gets things done.” Another commented, “It seems like the care workers are more caring now.”

Relatives also told us they thought mealtimes had improved and were less-rushed. One relative said, “The staff help people who can’t feed themselves and the meals are well-balanced and always look nice.” We observed that when meals were served the atmosphere was relaxed and happy and people had the assistance they needed.

Some of the people who lived at the home had limited communication and we were unable to ask them about their experiences.

Relatives’ views on the care provided were mixed. One told us they were ‘very satisfied’ and another said the care was good and rated the home 8/10. Two others said they had little confidence in quality of the care provided. We were concerned about dementia care in the home and observed that people were not always treated with respect (see Outcome 4).

There were also mixed views about nutrition. One of the people who used the service told us, “The food is pretty good – I quite enjoy it.” One relative said their family member had gained weight since coming to the home, but two others were concerned their family members had lost weight.

Some staff seemed more intent on supervising the people who used the service than interacting with them. A relative told us, “The staff are in here (one of the lounges) so why don’t they talk to the residents or do something with them?” However some staff communicated well with people. Another relative said, “They are always sitting with my (relative) and chatting to her.

Two relatives told us they’d raised concerns but were not been satisfied with how they’d been dealt with. One person said a staff member was ‘argumentative’ when they complained and ‘off’ with them afterwards. Another relative said they had raised concerns but weren’t sure if they had been recorded or not.

Most of the people who used the service were unable to give their views due to illness or disability. However we observed that people seemed happy and settled in the home. Staff were attentive to their needs and able to provide one to one care and social support when necessary We also spoke to two relatives who commented positively on all aspects of the service.

People were encouraged to make choices about their care, activities, and meals. A relative told is, “At mealtimes the staff bring round the menu and ask my relative what she wants. If I’m not here to help her decide they know her likes and dislikes so they choose for her.”

Relatives said the home provided a wide range of activities for people. Comments included, “The activities are good and although my relative can’t always take part she likes being there and getting a sense of being part of something.”, and, “The carers sit individually with the residents and reminisce with them. A lot of individual work goes on with the residents here.”

The staff team were enthusiastic about their work and had a warm and caring approach to the people who used the service. A relative told us, “The staff are always patient because they understand the residents’ needs.”

Relatives said the new acting manager provided good leadership. One person told us, “I have total confidence in the new manager, she’s a people person who puts relationships first, she listens, and she cares about the residents and the staff.”

People were satisfied with the care and support they received. One relative told us; “We are very satisfied. I am made welcome and my wife is well looked after.”

Others told us that when they requested help or support this was usually responded to quickly enough. There was a friendly relationship between the people who used the service and the staff. One person told us; “I have lots of fun with the staff and a good laugh. They are very kind and considerate towards me.”