Phoenix House is located in a residential area of Formby. The home provides accommodation and support for up to 30 people. The majority of people who currently lived at the home had some degree of memory loss.
There is disabled access and car parking. Communal areas include two lounges, a dining room and an enclosed back garden. There is no lift access on the second floor of the home therefore people accommodated on this floor need to be mobile as they are required to use the stairs. Nursing care is provided by a district nurse service when required.
This was an unannounced inspection which took place over two days on 25 and 26 February 2015. The inspection team consisted of an adult social care inspector, a CQC (Care Quality Commission) pharmacy inspector and a specialist advisor. This is a person who has experience and expertise in health and social care and for this inspection we had a specialist advisor who had a background in mental health. The specialist advisor attended the home on the first day of the inspection.
A registered manager was in post. 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.
We followed up on a previous inspection of 21 and 22 October 2014 where there had been a breach of the regulation regarding the safe administration of medicines. As a result of our findings during the inspection in October 2014 a compliance action was issued to the provider requiring them to take swift action to make improvements to the way medicines were managed at Phoenix House. The provider sent us an action plan which showed us the actions they were taking to ensure people medicines were being managed safely.
On this inspection we found we found that people living at the home were still not always protected against the risks associated with the use and management of medicines. People did not always receive their medicines at the times they needed them or in a safe way. We looked at the systems in place for managing medicines in the home. This included the storage and handling of medicines as well as a sample of Medication Administration Records (MARs), stock and other records for ten people living in the home. Overall, we found that appropriate arrangements for the safe handling of medicines were not in place.
A number of people living at the home had needs associated with memory loss so were unable to verbally share with us whether they felt safe in the way they were supported by staff. For this reason we spent periods of time throughout the inspection observing how staff supported people. Our observations showed people felt as ease with the staff and there was a good rapport.
We found staff levels were satisfactory at this inspection. Staff attended to people’s needs in a timely manner. No one was left waiting for assistance.
We looked at how staff were recruited. We looked at staff files and appropriate applications, references and necessary checks that had been carried out to ensure staff employed were suitable to work with vulnerable people. The necessary checks were in place to evidence this.
We spoke with the staff about abuse. Staff told us what abuse was and gave good examples to illustrate this. Staff knew the correct procedure to follow if they thought someone was being abused. Training records confirmed staff had undertaken safeguarding training.
We found the home were managing risks to people. For example risks associated with poor mobility, falls and nutrition. We saw the use of bed rails to minimise the risk of people falling out of bed and the use of sensors to alert staff when a person (who was at risk of falls) had got out of bed unaided. Where an increase in risk had been identified, measures had been put in place to help keep people safe.
The provider undertook safety checks of the environment to ensure it was safe and this was reported through their monthly audit (check) which we saw. General repair work was reported in the diary and actioned.
The provider and manager have actively sought guidance on and researched ways in which the lives of those suffering from dementia could be enhanced and their abilities maximised. This included changes to the home’s environment, coloured crockery for easy recognition and framed posters as a memory aid.
We found the home to be clean and tidy. Gloves and aprons were available for staff use when giving care and food preparation.
During our inspection we observed staff providing support to people in accordance with individual need. On the whole staff communicated well with people they supported. Over one lunch time however we observed minimal interaction by the staff when assisting people with their meals. Staff did not talk to people about their meals or engage in day to day chat, which is an important part of people’s social care. We brought this to the attention of the provider. During other times staff communication and interaction was good.
We talked with staff about a number of people’s care needs. Staff had a good knowledge of people’s individual needs and how they wished to be cared for.
We reviewed the care and support for five people who were living at the home. People had access to external health professionals and referrals and appointments had been made at the appropriate time. A person told us “I can see my doctor when I want, it’s not a problem.”
Staff received on-going training and support to ensure they had the skills and knowledge to meet people’s needs. Staff we spoke with confirmed they undertook training. A number of staff had a qualification in care, such as NVQ (National Vocational Qualification) or Diploma, which demonstrated a commitment to formal learning in care.
The service was working within the legal framework of the Mental Capacity Act (MCA) (2005) and also Deprivation of Liberty Safeguards (DoLS). The MCA provides a statutory framework to empower and protect vulnerable people who are not able to make their own decisions. In situations where the act should be and is not implemented then people are denied their rights to which they are legally entitled. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.
People living at Phoenix House Care home varied in their capacity to make decisions regarding their care. The provider informed us a number of ‘best interest’ meetings had been held. We looked at these records and found them to be completed and compliant with the requirements of the MCA.
In one case, there was no evidence that a mental capacity assessment had been carried out to determine whether the person had the capacity to understand the implications of refusing their medication. This was brought to the provider’s attention.
Although care staff did not have a theoretical knowledge of the MCA legislation they appeared to be integrating the principles of the MCA into their practice, which helped to transform the experience of adults with care and support needs. For example, assisting people to make a choice, giving them time and assisting them with their decision making when necessary.
Staff told us by talking with people they obtained their consent to assisting them with daily activities and care. Relatives told us they were consulted regarding decisions about their family member's care.
People told us the staff were polite and spoke with them in respectful manner. Staff told us ways in which they protected the dignity and privacy of people, particularly in relation to the provision of personal care. For example, always ensuring bedroom doors were closed when providing personal care. Relatives told us the staff were very caring and kind at all times and there were no restrictions on when they could visit. Their comments about the staff included, “Always kind and helpful” and “You could not have more kindness.”
Staff discussed with us how they encouraged people to be independent. People had the use of walking aids and we observed staff encouraging them to use these to help promote their independence.
People had a plan of care athough not all the care plans contained a level of information that would guide staff in providing personalised care. The manager advised us they were undertaking reviews of the care documentation to ensure it recorded information tailored to individual need; thus making them more person centred. Staff we spoke with were knowledgeable regarding people’s care.
We saw that people were offered a variety of activities that were thought out, stimulating, enjoyable and appropriate for the needs of those living with dementia. During the inspection the activity was a singer with guitar, who sang mostly 1950’s songs. People and their relatives joined in and this was very lively and enjoyable.
We observed a complaints procedure was in place and people we spoke with and relatives were aware of how to raise a complaint. We saw that any concerns or complaints made had been addressed and a response made.
Systems were in place to monitor the quality of the service. The provider had carried out audits to determine how well medicines were handled. These checks however, had failed to spot many of the concerns and discrepancies that we found during our visit. This meant there was not a robust system of audit in place in order to identify concerns and make the improvements necessary to ensure medicines are handled safely within the home.
People who lived at the home and relatives were given satisfaction questionnaires to provide feedback about the service provided.
Staff informed us the management of the home was open and transparent. Staff told us they were supported by the manager and provider and they would be confident in speaking to them if they had a concern. Staff we spoke with were aware of the home’s whistle blowing policy and they said they would use it.
You can see what action we told the provider to take at the back of the full version of this report.