This inspection took place on 4 December 2018 and was announced. At our last inspection in November 2017 we found a breach of the regulation in relation to safe care and treatment. This was because some upper floor windows were not appropriately restricted. However, the provider took action to rectify this by the time we completed the inspection. We also found one person was not receiving care in line with restrictions placed on their liberty by a supervisory body and that the registered manager did not always identify and act on problems such as those we identified at the inspection. We rated the service 'Requires Improvement' overall and in the key questions, 'Is the service safe?' 'Is the service effective?' and 'Is the service well-led?' In the key questions, 'Is the service caring?' and 'Is the service effective?' we rated the service Good.

Magnolia House 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. Magnolia House is able to accommodate up to three people within one building. At the time of our inspection there were two people using 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 a registered manager in post. 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.

People using the service were safe because the provider had appropriate systems in place to safeguard people from abuse and avoidable harm. This included management plans for people who had a history of engaging in risky behaviour. People had personalised risk assessments covering both generic risks and those that applied specifically to them. Risk management plans were designed to keep people safe without overly restricting their freedom.

The provider took steps to reduce the risk of infection spreading. They carried out a number of checks to ensure the premises were safe, well maintained and clean. This included the safe storage of medicines. People received their medicines as prescribed and the registered manager ensured staff were competent to administer them. There were enough staff to care for people safely.

The provider kept up to date with relevant guidance and worked alongside other providers to ensure the care they provided at Magnolia House was effective and in line with best practice. People had their needs assessed and care planned to take into account their specific needs in relation to healthcare and the provider worked with mental health professionals to meet their needs effectively. People had enough suitable food and drink to meet their needs. The home environment was suitable for the people who lived there and met their individual needs.

The provider understood their duties under the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). People received care that they had consented to and did not unnecessarily restrict or deprive them of their liberty.

Staff received support to provide effective care. The registered manager shared best practice knowledge with the staff team and staff received regular training, supervision and appraisals.

Staff cared for people in a compassionate and respectful way. People had good relationships with staff who understood them well. Staff knew how to communicate information to people in ways they understood to h

This inspection took place on 8 and 16 November 2017 and was unannounced.

Magnolia House provides accommodation and personal care for up to three people with a learning disability. 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. Three people were using the service at the time of our inspection.

The service had a registered manager in post. 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.

People using the service were not always kept safe. We found there were no restrictors on windows on the first floor, where people were at risk of falling from a height. In addition, this was not in line with guidance on national safety standards for people living in a care home. The registered manager had identified the risk of a person falling out of a window. However, they had not taken the necessary action to minimise the risk of avoidable harm. We issued a warning notice after our first day of inspection in relation to the safety of people using the service; by the second of day of inspection, the provider had taken appropriate action to address this concern.

Aspects of the premises were cluttered with fitness equipment, containers with activity aids and furniture. There were loose floor tiles in an office/lounge, an unsecured skirting board in one of the corridors, and insufficient lighting on the first floor landing, which put people at risk of falls, trips and/or injury.

People did not always receive the support they required in line with the restrictions placed on them by a supervisory body under the Deprivation of Liberty Safeguards (DoLS).

Quality assurance checks and audits were not always effective in identifying and resolving shortfalls at the service.

People received support from a sufficient number of staff deployed to meet their needs. The provider carried out appropriate recruitment checks and ensured they employed staff who were suitable to provide care and support.

People were protected from abuse because staff understood the provider’s safeguarding procedures to identify and report abuse. Staff minimised the spread of infection by following good hygiene practices.

People’s care was delivered by staff who were supported, supervised and appraised in their roles. Staff underwent training required to undertake their roles. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service did support this practice. Staff ensured they sought people’s consent before providing care and treatment.

People enjoyed the meals provided at the service and received the support they required to maintain a healthy and balanced diet. Staff supported people to access healthcare services when needed.

People were treated with dignity and respect. Staff respected people’s privacy. People told us the staff were kind, caring and respectful.

People took part in the assessment and planning of their care and support. Staff had sufficient guidance about how to provide people’s care. People received care that responded to changes in their health and support needs. People enjoyed taking part in a wide range of activities of their choosing.

The registered manager sought people’s views about the service and acted on their feedback. People using the service and their relatives knew how make a complaint if they were unhappy.

People using the service, their relatives an

This inspection took place on 14 October 2015 and was unannounced. At our previous inspection on 24 March 2014 the service was meeting the regulations inspected.

Magnolia House provides accommodation, care and support for up to four adults with a learning disability, some of whom may also have a mental illness. At the time of our inspection two people were using the service.

A registered manager was in post. 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 staff at Magnolia House provided an individually tailored service to the people living there. The registered manager undertook assessments to identify people’s needs and developed support plans instructing staff how they were to support people. Staff were knowledgeable about the people they supported. This included knowing people’s individual preferences, personalities, routines and interests. Staff provided the support people required with their personal care in a way that respected and maintained their privacy and dignity.

The provider had arrangements in place to support people with their healthcare needs and liaised with healthcare professionals as required. Staff supported people with their nutritional needs and ensured people received their medicines as prescribed.

Staff supported people to participate in a range of activities and people were busy accessing amenities in the community on the day of our inspection. Staff supported people to develop their skills, become more independent and achieve personal goals.

There were systems in place to encourage people to make decisions about how they were supported and how they spent their time at the service. Staff were knowledgeable about how people communicated, including non-verbal communication. Staff provided people with choices and respected their decisions.

The people using the service were assessed under the Mental Capacity Act 2005 as not having the capacity to make complex decisions about their care and welfare, and finances. ‘Best interests’ decisions about their care and treatment were made for people by the health and social care professionals involved in their care, and relatives where appropriate, when the person was unable to make the decision themselves.

Staff were aware of the risks to people’s safety whilst at the service and in the community, and provided them with support to maintain their welfare. Deprivation of Liberty Safeguards (DoLS) were in place to ensure people were only deprived of their liberty when necessary to maintain their safety, for example, when people were required to be supported by staff when in the community. DoLS is a way of making sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

Staff were knowledgeable in recognising signs of abuse and were aware of the reporting procedures to ensure people at risk of harm were supported appropriately. The registered manager worked with the local authority safeguarding team if there were any concerns about people’s safety.

There were sufficient staff at the service to provide people with the level of support they required. Staff had the knowledge and skills to undertake their role, and they were encouraged and supported by their manager to develop those skills.

Staff, people, relatives and visiting professionals were encouraged to feedback about the service and the registered manager was open to suggestions about how to improve service delivery. The registered manager worked with those involved in the care provided to people to ensure their individual needs were met, and followed advice and guidance provided.

The registered manager checked the quality of care provided and addressed areas requiring improvement. The registered manager adhered to the requirements of their registration with the Care Quality Commission.

We had previously undertaken a scheduled inspection of Magnolia House in September 2013. At that time we judged that the home was meeting the essential standards of quality and safety. We undertook this additional inspection because, since that time, some concerns had been raised. These concerns related to the homes procedures for reporting safeguarding vulnerable adults concerns to local authority and the Care Quality Commission.

We found that the provider had not always followed the proper safeguarding vulnerable adults reporting procedures. We also found that the provider had not notified the Care Quality Commission of incidents involving people using the service that had occurred at the home.

We spoke to one person using the service and their advocate. We also spoke to a relative of a person using the service.

The person using the service said “I love it here I would recommend it to anybody. I certainly have nothing to complain about here”. Their advocate said “There were a few issues to be ironed out when he moved in. I am satisfied at the moment that the home is meeting his needs and hope this continues. The other people who live there always seem to be happy, well dressed, well looked after and they go out quite a lot. The place is always clean”.

The relative of a person using the service said “My son is very happy there, he eats well, and he is well looked after, he is always well dressed and always presentable. The staff love him and he loves the staff, that’s all I can say”.

People using the service were receiving their medications as prescribed by health care professionals.

There were enough qualified, skilled and experienced staff to meet people's needs.

There were a range of systems in place to help monitor the quality of the service provided at the home.

People using the service had limited verbal communication skills which meant they were not able to tell us their experiences. We spoke to the relatives of two people, who told us they were happy with the care and support provided at the home. One relative told us “My relative is very settled, and seems happy there, they live in a comfortable home”. Another relative told us “My relative is well looked after physically and mentally, he goes out every day and he’s happy there”. Both told us there were lots of social activities which their relatives enjoyed and there was very good communication with staff and the registered provider.

We spoke to the care manager of two people who use the service. They told us “The people living at the home receive good support in particular with improving their skills and activities. Considering the needs they had when they first moved into the home I feel they are making tremendous progress. The relationship and communication we have with the provider is very good”.

People who use the service told us that staff treated them well. They showed us their bedrooms and told us they were happy with them.

A relative of one person who uses the service told us their relative had settled in well and their needs were being met. There were a lot of social activities which their relative really appreciated. They visited every week and sometimes they went to Church. They were invited to care planning and review meetings and had very good communication with staff and the registered provider. They told us “We were very lucky to have found this home, the staff are very good and the registered provider gives those little added touches going beyond the realms of what you would expect”.

We observed positive interactions between staff and people using the service throughout the course of our visit. Staff spoke and listened to people in a courteous and respectful manner.