This inspection took place on the 10 and 17 August 2017 and was unannounced.

At the last inspection the service was rated Good. At this inspection we found the service remained Good.

Magnolia House is registered to provide accommodation and personal care services for up to 46 older people and people who may be living with dementia. At the time of our inspection there were 39 people living at the home. The service is set over three floors accessible by passenger lifts and has a range of communal areas for people to use, including a communal lounge, quiet lounge, conservatory and dining room. The majority of bedrooms are for single occupancy and many have ensuite facilities.

The provider had arrangements in place to protect people from risks to their safety and welfare. Arrangements were also in place to store medicines safely and to administer them according to people’s needs and preferences. People were supported to access healthcare services, such as GPs and community nursing teams.

Staffing levels were sufficient to support people safely and in a calm, professional manner. Recruitment processes were followed to make sure only workers who were suitable to work in a care setting were employed. Staff received appropriate training and supervision to make sure they had the skills and knowledge to support people to the required standard.

Staff were aware of the need to gain people’s consent to their care and support. 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 supported this practice. The arrangements included processes and procedures to protect people from the risk of abuse.

People were supported to eat and drink enough to maintain their health and welfare. They were able to make choices about their food and drink, and meals were prepared appropriately where people had particular dietary needs.

People found staff to be kind and caring. They were encouraged to take part in decisions about their care and support and their views were listened to. Staff respected people’s individuality, privacy, dignity and independence.

Care and support were based on plans which took into account people’s needs and conditions, but also their abilities and preferences. Care plans were adapted as people’s needs changed, and were reviewed regularly.

People were able to take part in leisure activities which reflected their interests and provided mental and physical stimulation. Group and individual activities were available if people wished to take part.

The home had an open, friendly atmosphere in which people, visitors and staff were encouraged to make their views and opinions known.

Systems were in place to make sure the service was managed efficiently and to monitor and assess the quality of service provided. The provider took action where these systems found improvements could be made.

We spoke with ten of the 29 people who were living at the home. Most said they were satisfied with the way they were cared for. One person told us “They help me as much as I need but they don’t take over or anything but if I need more help it’s there.” Another said “it’s a good quality place this, you should see the effort they put in at Christmas, what a spread”. Whilst a third commented on the staff saying “everyone here is so nice and obliging, they are marvellous. They are always singing and smiling. You don’t have to worry about a thing even if you need some clothes mending they’ll do that for you too and the foods lovely too”. Where people identified concerns the manager and care records showed action was being taken to rectify the issues.

Although we were not able to have a conversation with some other people we met them and observed some of their care and staff interactions in communal areas. We spoke with one visitor. They were very positive about the care their relative was receiving. We also spoke with two visiting health professionals. Both told us they were consulted appropriately and felt their guidance and treatment plans were followed. They also said there was always a member of staff who was aware of the issues and person’s needs available to support them.

We spoke with a total of 14 staff. Some were on duty and other staff were attending the home for a training session. Staff were aware of how people should be supported, individual likes and dislikes and the help they required. Staff felt they had sufficient time to meet people’s needs, had completed a relevant induction and had ongoing training. Staff told us the home was well staffed and they were able to attend to people as needed. We found there were appropriate recruitment, induction and staff support procedures.

The care we observed and described by staff corresponded with care plans and risk assessments viewed. The home was clean and there were systems in place to manage infection control risks. There were also systems in place to monitor the quality of the service provided.

We spoke with five of the 41 people living at the home. They told us they had choices including what time they got up and meals. People told us staff were all very good although they were very busy. Two people told us they previously received care at the home and had decided to return when they had found it hard to manage in their own homes.

Other people had dementia and therefore were not able to tell us about their experiences. To help us to understand the experiences people had we used our Short Observational Framework for Inspection (SOFI2) tool. This allowed us to spend time watching what was going on and helped us understand how people spent their time, the type of support they got and whether they had positive experiences. We observed that staff were courteous and respectful of people's views. Choices were offered and where necessary informal consent was obtained. Staff knew what support they needed and respected people’s wishes. The support that we saw being given to people matched what their care plan said they needed.

We also spoke with visitors to the service, relatives and external professionals. They were generally positive about the home and care people received although they felt that staff were very busy. We found that people received an appropriate diet, medication was correctly managed and staffing levels had been adjusted to meet increased needs at night. Care plans were relevant to people and the necessary records were maintained.

We spoke to a number of the residents, their relatives and the staff. People told us that they were treated with respect and that the staff were very kind, courteous and respectful. People were offered choices and there was no restriction to time when they got up or went to bed. People commented that the staff were very good and attentive. They said that they could approach the staff and the manager with any concerns and were confident these would be addressed. One person said that the staff ‘always ask you what you want to do and they listen.’

People told us that the food was ‘very good and you have lots of choices.’ They told us that the staff assisted them in choosing from the daily menu. People told us that the home was ‘always very nice and clean.’ Relatives told us that they visited several times a week and found the care ’very good.’ Another relative said that ‘the care was superb.’

Visiting professionals said they attended the home regularly and the staff sought help and advice for the residents as appropriate.

This inspection took place on 30 July and 5 August 2015 and was unannounced. The home provides accommodation and personal care for up to 46 people, including some people living with dementia. There were 39 people living at the home when we visited.

There was a registered manager at the home. 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 and relatives were positive about the service they received. They praised the staff and care provided. People were also positive about meals and the support they received to ensure they had a nutritious diet. A range of daily activities were offered with people able to choose to attend or not.

Legislation designed to protect people’s legal rights was followed correctly. People’s ability to make decisions had been recorded appropriately, in a way that showed the principles of the Mental Capacity Act (MCA) had been complied with. Staff were offering people choices and respecting their decisions appropriately.

The Deprivation of Liberty Safeguards (DoLS) were applied correctly. DoLS provides a process by which a person can be deprived of their liberty when they do not have the capacity to make certain decisions and there is no other way to look after the person safely.

People felt safe and staff knew how to identify, prevent and report abuse.

Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely. There was an environment maintenance and improvement program with consideration and action taken to ensure the environment supported people living with dementia or those with visual perception difficulties.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people’s individual care needs. People had access to healthcare services and were referred to doctors and specialists when needed. Reviews of care involving people or relatives (where people lacked capacity) were conducted regularly.

There were enough staff to meet people’s needs. Contingency arrangements were in place to ensure staffing levels remained safe. The recruitment process was safe and helped ensure staff were suitable for their role. Staff received appropriate training and were supported through the use of one to one supervision and appraisal.

People and relatives were able to complain or raise issues on a formal an informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals. Staff worked well together which created a relaxed and happy atmosphere, which was reflected in people’s care.

The registered manager and providers representatives were aware of key strengths and areas for development of the service and there were continuing plans for the improvement of the environment. Quality assurance systems were in place using formal audits and regular contact by the provider and registered manager with people, relatives and staff.