Date of Assessment: 7 to 10 October 2024. This assessment was prompted by information we held about the service, including existing and emerging concerns. The assessment covered the entirety of the safe and well-led key questions, and parts of the effective, caring and responsive key questions. The service is a supported living service providing care and support to people with varied physical and mental health needs, including people with a learning disability and autistic people. The service consisted of several supported living schemes in and outside of London. We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. Safety was not always adequately managed. We found concerns in relation to assessing risks to people, ensuring people were protected from abuse or neglect, management of medicines, monitoring and reducing incidents, and staff training. In some cases, the way the service assessed people’s needs was not always efficient which could potentially impact the care provided to people. There were gaps in how the service managed complaints. We found inconsistencies and shortfalls in the governance of the service, including the effectiveness of quality assurance systems. Where improvements had been made, these were not always maintained across the different parts of the service. These concerns resulted in 3 breaches of regulations in relation to safe care and treatment, safeguarding and staffing, and 1 repeated breach of regulation regarding good governance. We have asked the provider for an action plan in response to the concerns found at this assessment. In instances where CQC have decided to take civil or criminal enforcement action against the provider, we will publish this information on our website after any representations and/or appeals have been concluded. However, we also found a number of examples of good care and good practice. For example, people received person-centred care and staff responded positively to their individual needs. There was an open culture where people and staff felt comfortable to raise concerns. There were also good support systems for staff.
PDF cached but not yet analysed by Claude; set ANTHROPIC_API_KEY and re-run npm run etl:reports -- --location 1-662701994.
Magic House received an overall rating of Requires Improvement following a focused inspection of Safe and Well-led, downgraded from Good, due to breaches of Regulation 17 (Good Governance) relating to inconsistent medicines audits, overdue staff training, and failure to notify CQC of safeguarding incidents. Strengths included personalised care planning, adequate staffing levels, effective infection control, and a positive, open organisational culture.
Concerns (7)
criticalSafeguarding: “a number of safeguarding concerns, which were being or had been investigated by local authorities, had not been reported to CQC”
criticalGovernance: “systems were either not in place or robust enough to assess, monitor and mitigate risks within the service. This was a breach of regulation 17 (Good governance)”
moderateMedication management: “guidance was generic and did not provide specific instructions. For 1 person who was prescribed an anticoagulant, no information was available around possible side effects”
moderateMedication management: “discrepancies in the way staff from different supported living settings carried out medicines audits...lack of uniformity around quality assurance systems for medicines management”
moderateIncident learning: “outcomes of safeguarding incidents were not always clearly documented which meant there was a risk the service did not effectively reflect on what went wrong”
moderateStaff training: “the majority of staff had not completed or refreshed their health and safety and fire safety training”
moderateRecord keeping: “for 1 former staff member, the management team had not completed a risk assessment around issues on their DBS to demonstrate they were suitable to work with vulnerable people”
Strengths
· Staff focused on people's strengths and promoted independence, enabling fulfilling and meaningful everyday lives
· People were supported to have maximum choice and control in the least restrictive way possible
· Each person had a detailed and personalised risk management plan with clear guidance for staff
· The service worked closely with local authorities when dealing with safeguarding concerns
· Sufficient staffing including 1-to-1 and 2-to-1 support for people with complex needs
Magic Life Limited retained its Good rating across all five key questions at this February 2020 inspection of its nine supported-living projects in London and Hertfordshire, serving 16 people with learning disabilities, autism and mental health needs. The service demonstrated safe medicines management, comprehensive person-centred care planning and strong governance, with the only notable concern being inconsistent staffing due to agency use, which management was actively addressing.
Concerns (1)
minorStaffing levels: “relatives did comment about the use of agency staff within some of the projects. This meant that people did not always receive care and support from a consistent staff team.”
Strengths
· Comprehensive, person-centred care plans reviewed monthly and tailored to individual needs, preferences and communication methods.
· Safe medicines management with complete MAR records, weekly audits, stock checks and competency-assessed staff.
· Robust risk assessments covering behaviours that challenge, health conditions and community access, reviewed monthly or sooner.
· Strong safeguarding culture with trained staff able to identify and report abuse, and a transparent registered manager.
· Proactive multi-agency working with GPs, speech and language therapists, social workers and mental health professionals.
Quality-Statement breakdown (24)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
Magic House HSCA was rated Good overall at its first CQC inspection in April 2015, with strengths in safe care, person-centred practice and compassionate staff. Effective was rated Requires Improvement due to inconsistent supervision and appraisals and limited staff knowledge of the Mental Capacity Act and Deprivation of Liberty Safeguards.
Concerns (3)
moderateSupervision / appraisal: “supervision meetings had taken place, these had not been carried out consistently and on a regular basis in accordance with the service's policy.”
moderateConsent / capacity: “some staff demonstrated a limited knowledge of what might constitute a deprivation of liberty.”
minorGovernance: “there was no documented minutes of these meetings and we discussed this with the manager. He confirmed that such meetings would be documented in future.”
Strengths
· Person-centred, detailed care plans signed by people and reflecting individual preferences and routines
· Sufficient staffing levels matched to individual needs with no concerns raised by staff
· Effective safeguarding procedures with staff able to identify types of abuse and reporting pathways
· Safe medicines administration with no unexplained gaps in MAR charts
· Positive, respectful caring relationships between staff and people using the service
Magic House, operated by Magic Care Solutions Limited, was rated Good across all five key questions at its July 2017 inspection, maintaining its 2015 rating. Minor issues were noted around lack of observed medication competency assessments and incomplete audit action recording, both of which the provider promptly committed to address.
Concerns (3)
minorStaff competency: “The service did not observe medicine competencies of staff which was highlighted to the operations and area manager.”
minorGovernance: “Each audit identified areas of concern and issues, however, the service did not always list the actions taken to remedy the concern or issues.”
minorLeadership: “The registered manager...was no longer with the company and was due to submit their de-registration application.”
Strengths
· People felt safe and staff demonstrated good understanding of safeguarding and whistleblowing procedures
· Individualised, person-centred risk assessments were in place and reviewed periodically
· Safe recruitment processes including references, identity checks and DBS checks
· Safe medicine management with monthly audits and medicine administration training for all staff
· Staff received mandatory and non-mandatory training, regular supervisions and annual appraisals
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier livesGood
effective: Adapting service, design, decoration to meet people's needsGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staff; Working in partnership with othersGood