This inspection took place on 30 April 2018 and 4 May 2018 and was unannounced on both days.

Magnolia House is a is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 96 people across four separate wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from avoidable harm and abuse. Staff had good knowledge of the types of abuse and how to report them. Systems supported staff to record and take appropriate actions in line with their safeguarding policies and procedures.

Assessments of risks associated with people's care and support had been completed to ensure people received safe care and support.

Recruitment included pre-employment checks to ensure people were of a suitable character to work in a care home environment. Staffing levels were consistently maintained to provide safe care and support to people.

Systems and processes ensured safe management of medicines and infection control.

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.

People received person centred care and support to meet their individual needs, considering their preferences. Staff could access training relevant to their role and received supportive supervisions both face to face and in the form of observational practice.

Staff encouraged people to be as independent as they could be and offered choices for people to maintain control of how they wanted to live.

People told us they felt staff were caring, considerate and kind to them. They felt staff respected their wishes and that their privacy, dignity and independence was maintained.

Policies were in place to support staff in promoting equality and recognising people's diverse needs.

Activities were centred around people's previous employment, interests and hobbies. People had a choice of attending both group and one to one close space activities or events.

Systems were in place and easily accessible for people or their relatives to raise a complaint if they wished to do so.

The provider sought feedback from people and their relatives to improve the service. Planning of care and support involved the person and their relatives or representatives so that they could make suggestions or voice any concerns.

Quality assurance systems identified when improvements needed to be made. However, we identified some minor areas that required further improvements to be made. This was a proportionately small area and overall the providers systems were effective in driving improvements in the service.

Further information is in the detailed findings below.

The inspection of Magnolia House took place on 3 and 5 February 2016 and was unannounced. At the last inspection on 10/12/2013 the service met all of the regulations we assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These regulations were superseded on 1 April 2015 by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Magnolia House provides accommodation and personal care for up to 96 older people. People who use the service may also have a physical disability, sensory impairment, mental health condition or be living with dementia. The home is situated in Cottingham, close to the city of Kingston Upon Hull, but in the East Riding of Yorkshire. The service is divided into four units: Maple Court, Willow Court, Cedar Court and Lavender Way. Maple Court is a separate unit where the safety of people living with dementia is more easily maintained, while the other three units are open plan and people can move between them at their will. Accommodation is mainly single occupancy with a selected number of bedrooms that are shared. A very high proportion of bedrooms have en-suite toilet facilities. There is a hairdressing salon on Lavender Way and a separate flat where one person lives that is much more independent and therefore has their own front door entrance with key. Gardens are extensive and secure.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager that had been registered and in post for the last four months. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We found that people were protected from the risk of harm because the registered provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns. Risks were managed and reduced on an individual and group basis so that people avoided injury or harm, wherever possible.

The premises were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. Staffing numbers were sufficient to meet people’s need and we saw that rosters accurately cross referenced with the staff that were on duty. We saw that recruitment policies, procedures and practices were carefully followed to ensure staff were ‘fit’ to care for and support vulnerable people. We found that the management of medication was safely carried out.

People that used the service were cared for and supported by qualified and competent staff that were regularly supervised and received appraisal regarding their personal performance. Communication was effective, people’s mental capacity was appropriately assessed and their rights were protected.

People received adequate nutrition and hydration to maintain their levels of health and wellbeing.

The premises were suitable for providing care to older people and we found that the unit designated to accommodating people living with dementia was also suitable for its purpose. Everyone that lived in Maple Court had their own front door in bold colours, with letter box, door knocker and memorable signage, so they could identify their bedrooms.

We found that people received compassionate care from kind staff and that staff knew about people’s needs and preferences. People were supplied with the information they needed at the right time, were involved in all aspects of their care and were always asked for their consent before staff undertook support tasks.

People’s well

We carried out this inspection to assess the progress that the service had made to become compliant with the compliance actions that had been made at the last inspection on 21 June 2012. At the inspection in June it was assessed that the service had not cared for people in a clean and hygienic environment or that they had been protected against the risks of unsafe and unsuitable premises. People had not been cared for by staff that were supported to deliver care safely and to an appropriate standard.

At this inspection we did not speak with people that lived in the home about these issues but we looked around the premises and we spoke with the manager. We found that improvements had been made to the environment and were on-going. We were encouraged by this and accepted the provider's undertaking that further improvements would be made. We will visit again to look at regulation 15 regarding the ongoing refurbishment of the home. We found that infection control and staff training issues had been addressed and the service was compliant with regulations 12 and 23.

We used a number of different methods to help us understand the experiences of people who used the service, because some of the people who used the service had complex needs which meant they were not able to tell us their experiences. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

We spoke with a small number of people who used the service who told us they enjoyed life in the home and found the care from the staff to be “Very good”.

People told us that their experience was a positive one. They were involved in the decisions about coming into the service and staff discussed their care and treatment with them. They were able to make choices and decisions about their daily lives, and the staff respected their wishes and supported their independence.

People told us that they were well looked after at the home and that the staff were very caring.

They said that the meals at the home were good and that there was plenty of choice.

People who lived at this home said it was a good place to live as the staff were polite, kind and helpful. Staff helped people to be as comfortable as possible, respecting their privacy and dignity. People said that the service would benefit from having more staff so that they did not have to wait for assistance.

We carried out two visits to Magnolia House in order to complete the inspection. During this time we looked around the home, spoke with nine people that used the service, two staff, a unit manager and the registered manager of the service. We also discussed some areas of the service with a director of the company and an operations director.

We found that people were consulted whenever possible about their care needs and wishes. We found that people were generally satisfied with the service they received, but that they were able to express their minor 'niggles' about things quite openly with staff. People said, "Everything is quite satisfactory. The staff are helpful", "I am well looked after" and "I don't require a great deal of help, but when I do ask for it the staff are helpful".

We found that the service had strategies for cooperating with other providers and organisations so that people received continuous care and support when moving between services.

People were protected from the risks of harm or abuse as the provider had safeguarding systems in place and the staff were appropriately trained. The provider protected people from the use of unsafe or unsuitable equipment and ensured equipment was safe by maintaining it as necessary.

People were assured of improvements in service provision because the provider had a system in place to monitor care and audit the overall performance of care and support. Complaints were satisfactorily handled and addressed so people knew their needs would be met.

Records held and maintained in the service were fit for purpose and were appropriately and securely stored, so people knew their information was kept confidential.