Magna House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last inspection we rated this key question as Good. At this inspection the rating has remained the same. This meant people were safe and protected from avoidable harm. The service provided care and treatment in a way which made people feel safe, supported, and listened to. People we spoke with felt they were treated with compassion, dignity and respect. They felt safe within the environment and were aware of contact points within the ward to gain help and support. People were supported to make choices which balanced risks of harm with positive choices about their lives. We found that people were encouraged to be involved in their care and treatment. Staff were observed engaging with people in a professional and caring manner. Staff were responsive and used their initiative to respond to the needs of people. The wards were safe and clean. Staff had clear roles and responsibilities for managing and improving safety and were aware of policies and procedures to minimise restrictive practices and manage risk. Leaders ensure there are enough skilled people to deliver safe care that promotes choice, control and individual wellbeing.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff said they assessed referrals into the service following the correct protocols to ensure the correct care and support is available and suitable for people. Staff said that all people were offered one-to-one time with their named nurse or key worker. This would be left in place for the duration of the admission to provide continuity and build a relationship with the patient. Staff said that they had good communication with other agencies both internal and external who were involved with people. This process was completed in a timely manner to enhance and ensure the quality of care and continuity of support provided. Staff said that they regularly reviewed risk assessments and updated these to reflect people’s current risks and needs. These updates would be discussed with staff during handovers and daily meetings, however documentation of this within the online system was difficult to see.

The service worked collaboratively with partners to prioritise safety and continuity of care. Partners told us they attended quality visits to monitor and support the service. However, partners did not always feel included in discussions during weekly ward round multi-disciplinary team meetings.

The service’s referral and admission processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met. However, we were not assured that staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and post-discharge. A review of 4 multidisciplinary team meeting minutes showed that partners were not routinely involved in discussion about patients.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

People said that they felt safe and supported while living on the ward. People said they were supported to manage any risks with possible outcomes outlined. People said that they felt safe and supported to approach staff to raise concerns regarding a decline in their physical and mental health

Staff told us that people are informed about risks and how to keep themselves safe. Risk assessments about care were person-centred, proportionate, and regularly reviewed with the person, where possible. Restraint is only ever used as a last resort. If staff use restraint, it is lawful, for a legitimate purpose, safe and necessary, and staff always follow best practice. Staff said that they had completed mandatory training in reducing restrictive intervention training (PRICE) to manage risk and incidents. However, documentation of this within the online system was difficult to see.

The service had a Restrictive Practice and Management of Violence and Aggression policy documenting that restraint is only ever used as a last resort and the service does not permit seclusion. Restrictive practice audits showed that there were 178 incidents involving physical restraint across the service from 1/8/2023 to 09/07/2024 and 53 incidents involving rapid tranquilisation. There were no recorded incidents of seclusion or long-term segregation or use of prone restraint. Staff had access to a patient search policy, which was detailed and gave clear guidance on when staff would carry out searches on patients, their belongings and bedrooms. It guided staff to seek consent before conducting searches. There were several banned and restricted items on the ward area to help maintain patient safety. We reviewed 4 multidisciplinary team meeting minutes and 19 care plans which showed that staff worked with people to understand and manage risks.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Patients said that they felt staff had the relevant training to keep them safe on the ward and that they were caring and mindful in their approach when supporting them. Patients said that they felt safe and supported to approach staff to raise concerns regarding a decline in their physical and mental health. Patients said that they attended their multi-disciplinary team (MDT) and one-to-one meetings and felt involved in decisions around their care including changes to prescribed medication, however they felt that it would take some time to get an answer from a doctor or consultant. Patients said that staff did offer support and were able to provide information and guidance around staying physically and mentally well.

Staff said that safe staffing numbers were two nurses and five healthcare assistants per shift, the staffing numbers were increased when needed to reflect the demands of the ward but would not reach below the stated level. Staff said that they were very rarely short staffed and were able to increase staff at short notice if required. The staff were happy that they were able to use their core staff as they could pick up additional hours compared to using agency/bank staff that can cause short term operational difficulties such as the staff not knowing the building and patients. To address the safety of the patients and other colleagues, staff said that they had pinpoint personal alarms and radios with senior staff also having access to pagers. Staff said that they all have completed mandatory training which was relevant to the role and that additional training courses will be provided by Magna House such as English language lessons and guidance in writing support plans. Staff said that patient activities and leave were sometimes delayed but rarely cancelled due to staffing issues.

The appropriate staff numbers for patient and observational needs were witnessed within the wards and communal areas. Staff were present throughout the ward and observed completing observations in both the communal lounge area and bedspace corridor depending on the location and observation level of the patient. There were adequate staffing numbers to care for and support patients outside of the observational demand. The ward office was situated with a good view of the ward corridor, supported by CCTV and ceiling mirrors, which enabled staff in the office to observe the environment and provide care and support if needed.

A review of the staffing rotas showed the service met safe staffing levels with appropriately qualified staff assigned to each shift. Management adjusted staffing levels according to the needs of patients and used agency and bank staff for 9% of shifts during the month of June. During these periods managers made sure that permanent staff were regularly on shift to provide support where needed. At the time of our onsite assessment, levels of staff sickness across the service was 1.92% and the staff vacancy rate was 10% for nursing staff with 2 vacant posts and 1 vacant Dr post, however the service did have plans for recruitment and used locum Dr’s to cover shifts. The service had appropriate recruitment practices in place to make sure that all staff, including agency staff, are suitably qualified, competent and able to carry out their roles. There was an appropriate induction process in place for new staff and all staff completed mandatory training in line with guidance. The mandatory training compliance rate for the service was 97%, which was above the providers policy of 85%. However, it fell below this rate for Immediate Life Support (78%) and PRICE training (81.14%). Managers supported staff with regular supervision and annual appraisals and held monthly reflective practice sessions with staff. However, the annual appraisal and supervision rate had fallen since our last inspection from 97% to 89% and from 100% to 76.34%. Agency and bank staff were given a local induction, which included support to access the clinical records system. The service monitored the professional registration and renewal dates for their clinical staff in line with guidance. The service had an employee wellbeing and stress at work policy and took part in national initiatives to support employee mental wellbeing, for example, Mental Health Awareness Week.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.