Phoenix Care At Home Limited

Phoenix Care At Home Limited is a domiciliary care service providing personal care to people living in their own homes. The service provides support to people with a range of health conditions. At the time of the inspection, the service supported 18 people.

People’s experience of using this service and what we found

People received exceptionally compassionate care from committed and caring staff. People achieved better outcomes as a result of the care they received. The management team worked hard to instil a culture of care in which staff valued and promoted people’s individuality, protected their rights and enabled them to flourish. People and relatives spoke highly of the service provided by Phoenix Care At Home Limited (hereafter referred to as Phoenix).They all told us how staff went ‘above and beyond’ telling us how their support had been life changing and describing the care staff as ‘family’. The provider focussed on reducing the risk of social isolation and loneliness amongst the people they cared for. Comments included, “I was withdrawn and had stopped going out. The benefits to me are I have started going to a coffee morning. It allows me time in my garden. If I have a carer I can go into the garden. I go to a friend around the corner. I have such a good relationship, bless them” and, “They make my life worth living, they are very good.”

Staff were motivated to provide the best care they could for people, in line with their preferences and wishes. They told us, “When I meet a new client, I ask them how they like things done. I say, "I’m sorry if I’m asking a lot of questions. I want to get it right.” They were passionate about their role, and the people they supported. The management team gave us examples of small acts of kindness undertaken by staff, which made a real difference to people's well-being, for example putting up Christmas decorations and cooking Christmas dinner for people who lived alone; and arranging the funeral for a person who had no relatives, with carers contributing to the eulogy. Staff had taken their hand-held computer to a person’s house so they could facetime their family in Australia.

The support provided was responsive and flexible, and staff responded to requests for additional support outside of people’s commissioned care. One person told us, “I have called them out in the middle of the night…they are there. They always say if you need me call me.” The service had fund raised to purchase and maintain a wheelchair accessible vehicle for the use of people and their relatives, and equipment to help people up following a fall so they would not have to wait a long time if the ambulance was delayed.

People were supported by a small, consistent team of staff who knew them very well and the support they needed. This meant they could recognise if something was wrong, or there was deterioration in physical or mental health, and needed additional or specialist support. There were no missed visits, and staff always stayed for the commissioned time or longer. They had the time to spend talking with people, going for a walk, or carrying out additional tasks.

People were valued as partners and experts in the running and development of the service. One person had designed the satisfaction survey used to gather people’s views, and another contributed to practical staff training in manual handling, taking part and devising questions to ask staff.

People told us they felt safe with their care workers. Staff understood the risks to people’s safety and wellbeing, and what they should do to minimise them. They knew how to identify and raise concerns about safety and were confident action would be taken to protect people. People were supported with medicines safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were effective measures in place to protect people from the spread of infection, with government guidelines followed related to the use of personal protective equipment (PPE), staff testing and vaccination. During the pandemic the staff team minimised their own contacts with others to avoid bringing Covid 19 to the people they were supporting and took on work from private cleaners and hairdressers to reduce the number of professionals coming into people’s houses and the risk of exposure.

Systems were in place to ensure the right staff were recruited. People were supported by staff who

were inducted into the service with relevant training. This was refreshed regularly to ensure knowledge and skills remained up to date. The provider worked with other healthcare professionals for the benefit of people using the service. A health professional told us; “They use their initiative and go above and beyond in everything they do. They are very competent.”

People, relatives, staff and health professionals spoke highly of the management of the service. The management team were ‘hands on’ delivering care alongside the staff team. This meant they knew people and staff well. Staff told us, “The leadership is amazing. I couldn’t praise them more.”

There were systems in place to monitor the safety and quality of the service. This included ensuring regular feedback from people using the service and their relatives, and making any changes or improvements required.

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

Rating at last inspection and update

The last rating for this service was outstanding (published 03 July 2019)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Phoenix Care At Home Limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service:

People, their relatives and healthcare professionals all gave extremely positive views of how well this service met people’s individual needs. There were examples to show the staff went above and beyond their role to provide people with exceptional care and support. This included for example, one staff member saw someone looking unwell in the village- took them home, checked their blood pressure and made them some lunch, all in their own time. Another staff member took a person’s hearing aid to the hospital to be fixed on their day off as they knew how much the person needed it. Acts of kindness and caring were embedded into every day practice. Staff frequently thought “outside the box” to ensure people’s needs and emotional welfare was met. The whole culture of the service was that of caring.

People said staff were very kind, caring and thoughtful towards them and their family and pets. One said, “I was very anxious to accept any help especially in my own home, but I can honestly say they are like angels, they are so caring, and I really appreciate what they do for me.” Another said, “They are the best, I wouldn’t have anyone else.”

One healthcare professional said “I find them really excellent - always helpful and really take care of their clients. They certainly go the extra mile for people.”

The service ensured care and support was truly person centred and highly responsive to people’s needs. For example, the office would rearrange visits at short notice if someone needed assistance to get to an urgent appointment or required extra support due to ill health. When pieces of equipment were needed for changing need, the registered manager or provider went out of their way to get this in place at short notice. The service was responsive to people being isolated and lonely and went above and beyond their contracted hours to meet this need. For example, organising social events for people to meet up with carer, workers and other people in their area.

People were protected because risks had been assessed and any measures needed to mitigate these were fully documented. New staff were only recruited once they had all their checks to ensure they were suitable to work with vulnerable people. People’s medicines were safely managed.

People were supported where needed to maintain good nutrition and hydration. People’s health and emotional wellbeing was closely monitored and responded to when needed.

Staff were knowlegable about people’s needs and wishes. People were treated with respect and their dignity and privacy was upheld.

The service had an open and inclusive culture and the registered manager and nominated individual were continually thinking of ways to be innovative and responsive. They had recently moved offices to be in the heart of the village. They were offering people trips to visit the office and have coffee free of charge.

There were quality assurance systems in place to assess, monitor and improve the quality and safety of the service provided.

Rating at last inspection: At the last inspection we rated this service overall outstanding (report published November 2016). At this inspection we found the service remained outstanding in two key areas and is therefore rated as overall outstanding.

Why we inspected:

This was a planned comprehensive inspection based on the last report rating.

Follow up:

We will continue to monitor the intelligence we receive about the service. If any concerning information is received, we may inspect sooner.

The last inspection was completed in February 2014 where we found the service to be fully compliant in the areas we inspected.

The agency had a registered manager. 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 leadership and management of Phoenix Care At Home Limited was strong and very responsive to people’s needs. The ethos of the service was to provide high quality and person-centred support to people. The registered manager and director led by example, working alongside a committed staff group. The ethos and values were owned by management and care staff alike, ensuring people were at the heart of everything they did. This was evident by the effective ways the agency listened to people and welcomed feedback. People’s views and opinions were used to drive up improvement. Staff were well trained and supported and this enabled them to deliver the best possible care to people. Staff consistently said the agency was a ‘‘Great place to work.’’ Staff felt valued and appreciated and were therefore willing to help out when there was sickness or holidays. There had been no missed visits.

People repeatedly praised the kindness and compassion of staff, one person said ‘‘The staff are excellent. I would give them 10 out of 10. Always polite and very kind. They do any extras and go that extra mile for me.’’

In the feedback we obtained during the course of this inspection, we were given numerous examples of times when staff had gone above and beyond people's expectations to provide truly personalised care. This included fundraising to purchase a wheelchair accessible vehicle so people could be supported to go on holiday, for trips out or simply to attend health appointments. One example given was where staff had supported a person to attend a family occasion. The member of staff went back, out of the normal working hours, to provide transport for the person back to their home.

Management and care staff had a good understanding of people's needs and wishes and consistently went the extra mile to communicate with and support them effectively. Where it was clear people’s needs had changed, the registered manager and director worked with the person and their family to check if the package of care needed changing to accommodate their additional care needs. Staff said the agency was very responsive to their feedback.

People and their relatives recognised and appreciated these efforts which allowed them to receive their support in a way that made them feel safe and in control. One relative told us, “Phoenix Care are not the cheapest, but they are the best. They have matched up a lovely care worker for my (relative) I know they are safe and I can have peace of mind when I go out.’’

People were protected by the robust recruitment systems which ensured only suitable people were employed to support them. The registered manager was committed to only accepting new care packages where she was confident that the service had sufficient care workers with the right skills to care for people appropriately. As a result people told us that the agency had never missed a call and that their care workers usually arrived on time and always stayed for the entire time allocated. People also said the service was responsive to their needs and that staff went the extra mile to assist them. This included making sure people attended their healthcare appointments as well as finding ways in which to combat social isolation for people. The agency had their own holiday bungalow which they used for social events and invited people who used the service to meet up.

Staff worked in ways which showed the service was personalised, caring and compassionate. For example staff assisted people to maintain contact with their family and friends, helping them attend local events and learning new skills so they could enjoy time with a person who had that particular interest. People’s pets and their needs were considered as part of their care package. The agency helped people to rehouse or look after pets when they needed to go into hospital.

There was a culture of learning from mistakes and an open approach.

Systems had been used to ensure accidents, incidents and near misses were reviewed and used to make changes to help improve the service. In addition the management team used a variety of ways to gain the views and opinions of people and staff. This meant people were at the heart of the service and their opinions mattered.

We spoke with eight people who received a service and with three relatives of people who received a service. Everyone we spoke with were complimentary about the care and support provided. Comments included ''I have no complaints, they are first class.'' One relative said ''They are very good, they understand what needs to be done and get on, it gives me a peace of mind.''

We found that care and support was being well planned in a person centred way ensuring the needs and wishes of people were fully considered and detailed within their care plans.

Staff supported people appropriately with their medications as they had clear policies and procedures in place and received regular training to ensure they were competent.

We spoke with four staff who confirmed the agency provided good support and training to ensure they could do their job safely and effectively. We saw training records and staff supervisions supported this.

We found the agency had a robust complaints process and always investigated any concerns or complaints promptly with people being responded to in writing as well as verbally. People we spoke with said they felt any concerns they raised would be listened to and acted upon.

We spoke with four people who use the service and with two care staff. We heard that people felt that the care and support given by the agency was person centred and met their needs. Comments included '' This is one of the best agencies. I have no problems. They do exactly what they need to do and the staff are all very good.'' Another person said ''They are always very kind and caring. You could not ask for better.''

We saw that care and support was well planned, with people being involved with deciding how their care should be delivered. Where risks were identified, plans were in place to minimise those risks.

We saw that the service had robust recruitment processes in place. These help to protect people. Staff all have received training in the protection of vulnerable adults and understood what the processes were for reporting any concerns. This also helps to keep people safe.

The agency had developed ways of making sure people had their say, via surveys, care plan reviews and more informal get togethers with other people and care staff. The service reviewed how it works on a regular basis to ensure that they continue to provide quality care and support to people.