Phoenix Lodge

Phoenix Lodge is registered to provide accommodation and personal or nursing care for up to 16 people with a learning disability and/or autism across three dedicated houses. At the time of the inspection there were 16 people receiving care at the service.

People's experience of using the service and what we found

The provider did not fully ensure effective governance and oversight of the service for the quality and safety of people’s care and timely service improvement when needed.

Arrangements for staffing and risk management strategies to monitor, report and analyse people’s safety were not always sufficient to consistently ensure people achieved the best outcomes.

Staff knew how to recognise and report abuse but were not always confident to do so. When things had gone wrong, the incident reporting and review process did not always identify how to prevent the same thing happening again.

Staff generally understood people’s care needs, individual characteristics and daily living preferences, which they followed. People’s related care plans and their needs assessments were not always accurately maintained to fully inform people’s care. Some improvements actions were in progress to help rectify this.

The provider’s arrangements for people’s medicines and prevention and control of infection at the service helped to ensure people’s safety.

People were generally happy living at the service and relatives felt people were safe and comfortable there. Staff, people and relatives were often engaged and consulted to help inform or improve people’s care.

The provider worked in partnership with relevant authorities and external care professionals to help enhance and inform people’s care, independence and equipment needs.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. People had choice, control and independence and their privacy, dignity and human rights were promoted.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (Published March 2019)

Why we inspected

We received concerns relating to people’s safety. This included staffing, safeguarding, risk management and incident reporting practices within the service. As a result, we carried out a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.

We have identified a breach of Regulation in relation to governance at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; promotion of choice, control, independence and inclusion. For example, people's support focused on them having as many opportunities as possible to gain new skills and increase or maintain their independence.

People and staff told us they felt safe at the service. People received support to take their medicines safely. Risks to people's well-being were recorded and updated when their circumstances changed. Staffing was provided at safe levels that enabled people to go out and access the community when they chose to with support.

People's rights to make their own decisions were respected. People were supported to access healthcare services if needed. Staff had appropriate skills and knowledge to deliver care and support in a person-centred way. There were a lot of new staff at the service and they told us they felt encouraged by their training and welcomed by the current staff team.

The emphasis of support was towards enabling people. Staff encouraged positive risk taking so people could experience new things and develop. This had led to people feeling fulfilled and living an active life. People were complimentary about their staff and the positive relationships they had with them.

The values of the organisation of offering choice, inclusion and respect were embedded. This supported people to receive a positive service. Staff were aware of their roles and responsibilities. Work to continuously improve was noted and the new management team were keen to make changes that would impact positively on people’s lives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection: At the last inspection the service was rated Good (report published July 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

More information is in the detailed findings below.

This inspection was unannounced and took place on the 12 April 2016.

Phoenix Lodge is a registered care home and consists of three houses, The Lodge, The Cottage and The House, it is situated in New Mills. The service offers personal and social care to a maximum of 16 adults with a learning disability. Some people have associated conditions that may include, autism, sensory and communication difficulties. At the time of the inspection there were 15 people using the service.

Phoenix Lodge is required to have a registered manager. There was a manager who was in the process of registering with the Care Quality Commission. 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 home was person focused and accounted for people’s personal likes, dislikes, needs and preferences. We found staff encouraged people to make their own day to day decisions and staff respected those decisions whilst ensuring, and being aware of people’s safety.

People were encouraged to take part in activities of their choice. The staff supported and motivated each person to participate in activities; staff were aware of promoting people’s independence.

People’s right to privacy and dignity was promoted and respected by the staff.

People were cared for and supported by staff who had demonstrated their suitability for the role. The provider had pre-employment checks and recruitment procedures in place to ensure staff were safe to work within the care sector.

Staff were aware of how to protect people from potential harm; local safeguarding procedures were understood by staff. Any alleged abuse or concern was recorded and reported to the local authority in a timely manner.

New staff completed a period of shadowing and induction training prior to them supporting people with their care needs. The provider arranged training for staff, to ensure they were providing appropriate and effective support for people.

The principles and requirements of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards had been met. Best interest decisions and capacity assessments had been completed when required and were in people’s care plans.

Staff felt supported by the manager and the management team. Staff felt there was good team work being carried out.

Medicines were stored, administered and disposed of safely and in accordance with current guidance.

People’s bedrooms were decorated in a manner that reflected the needs and personalities of each person.

Effective auditing systems were in place to assess and monitor the quality of the service. Meetings took place with the staff and the people living at the service to collect their opinions and views.

The registered manager was not available at our visit but we were able to speak with the deputy manager who had a comprehensive knowledge of the service. We spoke with four members of staff of different grades.

This is a summary of what we found.

Is the service safe?

We saw that people were being cared for in an environment that was safe and clean. There were enough staff on duty to meet the needs of the people living at the home. A member of the management team was on duty on each shift and available on call in case of emergencies.

Staff received appropriate training and support. This meant the provider could demonstrate that the staff had the skills and experience needed to support the people living there.

CQC monitors the operation of the Deprivation of Liberty Safeguards. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005 (MCA). They aim to make sure that people in care homes and hospitals are looked after in a way that does not restrict their freedom inappropriately. The safeguards should ensure that a care home or hospital only deprives someone of their liberty in a safe and correct way and that this is only done when it is in the best interests of the person and there is no other way to look after them. There were no authorisations restricting the freedom of anyone living at the home in place at the time we visited but proper policies and procedures were in place and the Code of Practice was available. Senior staff understood when an application should be made and how to submit one.

Is the service effective?

The people we spoke with told us that they were happy with the care they received and their needs had been met. They all spoke positively about their care and the staff who supported them. It was clear from what we saw and from speaking with staff that they had a good understanding of the care and support needs of the people using the service and that they knew them well. We saw from the training records we viewed that staff had received training to enable them to meet the needs of the people living at the home.

Is the service caring?

We saw that the staff showed patience and gave encouragement when they were supporting people and that people were able to do things at their own pace and were not rushed.

Is the service responsive?

People's needs had been assessed before they moved into the home. The records we saw confirmed that people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

The atmosphere at Phoenix Lodge was relaxed and homely; we saw how the staff and the people who used the service worked together and it was clear that there were good relationships between them.

There were large gardens with seating areas and exercise equipment. There was a ramped entrance and a lift. Accommodation was provided in three units providing varying levels of support. We saw that rooms were spacious, light and clean and people had their personal belongings in their own rooms. Some people had pets.

Is the service well-led?

We found from speaking with staff that they had a good understanding of the home's values and beliefs. They told us about their roles and responsibilities and they were clear about these. We found that quality assurance processes were in place to make sure that the provider monitored the care provided and made improvements where necessary; for example, satisfaction surveys had been completed by people using the service, their families and by staff. The results had been analysed and published in the guide to the service. The staff we spoke with told us how the management team had considered their views and had implemented changes as a result. A variety of information was displayed, such as details of local events, local advocacy services, a service user guide and code of conduct.

We spoke with one person who lived at Phoenix Lodge. They said they were happy living there, and said they had a very nice bedroom. We also spoke with one relative who described the home as: 'Very good. There is good communication between me as a relative and the staff, and I've just had a short meeting with the manager to discuss progress. I can visit when I like, and the staff make me feel quite welcome.'

Two staff who we spoke with said they were happy working at Phoenix Lodge, as there was a good staff team, and lots going on. Staff also said that there were good training opportunities available and they felt well supported.

We found that people received care and support that protected their rights and met their needs from staff that were properly trained and supported.

At the time of our inspection the provider did not have a registered manager in post. Although the acting manager said they were close to submitting their application.

The staff we spoke with were confident and able to fully explain their duties and responsibilities, they told us of the support they received from their colleagues and managers and how they benefited from this support. Throughout our visit we saw staff respect peoples choices and ensure their dignity and safety was maintained at all times.