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Archived: Phoenix Healthcare & Recruitment Good

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Reports


Inspection carried out on 5 & 6 March 2015

During an inspection looking at part of the service

This inspection took place on the 5 and 6 March 2015. At the last inspection on 29 July 2014 we asked the provider to take action to make improvements in how they provided care to people and how they supported staff to carry out their role. Improvements had been made in all areas.

At the time of this inspection the manager had been in post for six weeks and was in the process of applying to the commission to become the 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 manager was aware of areas of the service that needed improvement and was working towards making those improvements.

People were protected from the risk of harm as staff had been trained to identify signs of abuse and knew how to respond to concerns. People’s relatives told us they felt safe using the service. Risks identified in the care planning process were recorded and staff were able to describe how they kept people safe. Where concerns were raised about the conduct of staff the provider took appropriate action to keep people safe.

People’s relatives told us staff were punctual and reliable. They turned up on time for visits and there were no missed calls. The provider was taking action to install a new computer system which will help them monitor the times of visits and the whereabouts of the staff.

People’s relatives told us and documentation showed people’s medicines were administered safely. They told us they trusted the staff who provided care as they had been trained to deal with the specific needs of each person. Care plans were kept up to date and communication was maintained between the office staff and the families to ensure any changes were recorded and appropriate action was taken.

We have made a recommendation about assessing people’s ability to make decisions about their care and giving consent. People with complex health needs were supported by trained staff in maintaining their food and fluid intake. Staff knew who needed specific support with regards to food and drinks, and the importance to people’s health and welfare. When changes occurred to people’s health staff knew how to respond appropriately.

People’s relatives told us staff treated the people they cared for with kindness and compassion. They told us they valued the staff and had a good relationship with them; they felt able to raise concerns or issues with the provider. People or their relatives were involved in the needs assessment completed before care commenced and in approving the final care plans and risk assessments. Care plans were monitored and updated when changes occurred. Staff spoke confidently about the needs of the people they were caring for and understood how to protect people’s dignity and privacy. They were also aware of how to support people to raise concerns or complaints.

People told us the service was well managed. People’s relatives told us the provider and the staff treated people with respect. They felt the person was cared for in a way that valued them as an individual. The manager was accessible to staff and had already implemented changes to increase staff motivation and to acknowledge the work they did.

Inspection carried out on 29 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

This was an announced inspection, we gave the provider 48 hours notice prior to the inspection to ensure we had access to senior staff and information. Phoenix healthcare provides care and support to people in their own homes. They provide this to adults and children with learning disabilities, physical disabilities and to older people living with dementia. At the time of our inspection they were supporting 19 people.

At our previous inspection in March 2014 the provider was meeting the requirements of the law in relation to consent to care and treatment, care and welfare of people, safeguarding people from abuse and how the quality of the service was monitored.

The service did not have a registered manager in place at the time of this inspection. The previous registered manager had not been working at the service for the two months prior to the inspection. The deputy manager had been covering in their absence. They had not registered with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. At the time of the inspection the people we spoke with and the staff were unclear of the management structure within the service.

We had difficulty accessing information about people’s care and how the service operated at the time of the inspection and afterwards. This was because the acting manager was not fully aware of what information the provider held or where to locate it. After the inspection the acting manager failed to respond to requests to send us further information. Not all information we requested was provided.

People told us contradictory things about the service they received. While some people were very happy, others were not. Our own observations and the records we looked at did not always match the positive descriptions some people had given us.

People’s safety was being compromised. One relative told us staff had not turned up on time for calls and some calls had been missed. Other people told us the staff turned up regularly on time and the service was good.

Risks identified in people’s care plans had not all been assessed. Training for staff in relation to risks and promoting some people’s health had not been provided. For example, how to protect people’s skin from pressure damage. Staff said the online training that was provided in other areas was not effective or helpful. Staff did not recognise and take preventative action when a person’s health deteriorated. Their relative felt the delay in the staff response meant the person’s recovery was prolonged.

Senior staff did not know how to identify possible abuse or how to report it. People’s mental capacity to make decisions and choices for themselves had not been assessed. This meant the provider could not show if they were acting in the person’s best interest. Staff did not always have access to the detailed guidance they needed to safely and effectively support people whose behaviour could be challenging.

Staff cared about the people they supported. They had formed relationships with people and told us they knew how to provide care and support in the way the person wanted. However, care plans were not reviewed at regular intervals which meant they may not be up to date or effective. Where people or their relatives had been given the care plan to approve, their comments or changes had not always been taken into account.

There was no evidence the provider regularly requested feedback from staff or people or their representatives on how the service could improve. The provider failed to meet their legal obligation of sharing information with the CQC regarding events that occurred within the service. This was because they did not know how and when they had to do this.

The provider had in place a complaints procedure. People and their relatives told us when they had made complaints the provider had listened and taken action to improve the service. They told us they were satisfied with the service they were now receiving.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 6 March 2014

During a routine inspection

This domiciliary care agency provided personal and nursing care to people with a range of support needs in their own homes. We spoke to three relatives and three members of staff. We reviewed a range of documents including care plans and staff records.

A nurse told us that it was important to ask the person�s permission �Would you like me to?� before giving care.

A relative described the provider�s staff as �extremely good and very professional�. Another relative told us that �we are lucky to have regular carers� and that they �give the necessary care and support�.

A relative told us that carers try to make the person�s life �as good as it can be�.

People who use the service told us that the provider�s service enhanced their safety, �very much so� according to one relative.

A relative told us that they were �completely happy� with the provider�s service.

During a check to make sure that the improvements required had been made

Since our last inspection, the manager has undertaken the necessary changes to the guidelines for staff in relation to safeguarding vulnerable adults from abuse. The process now describes the local multi agency agreement for providers in Buckinghamshire in how to respond to concerns of abuse. The guidance now highlights the need for staff to prioritise the safety of the alleged victim before taking further action.

The senior staff member has since attended the relevant training in responding to allegations of abuse.

These actions will reduce the risk of harm to people that use the service.

Inspection carried out on 12 March 2013

During a routine inspection

The manager told us that their aim was to offer a bespoke service to people. They ensured that people�s needs were clearly assessed. They provided a staff team who were skilled and trained in the necessary areas.

We found care plans and records relating to people who use the service were clear, informative and up to date.

The staff we spoke with were clear about their roles and responsibilities. Staff we spoke with demonstrated their understanding of how to protect people�s dignity and privacy. They showed an understanding of risk assessments and how they applied this knowledge daily to ensure their own safety and those of the people they were supporting.

Staff were clear about what would constitute abuse. However, there was the potential for people to be at risk as the written procedures were not inline with current guidance.

A family member told us "how delighted we are with the service, it has gone beyond mere duty of care and I really appreciate it.� A person who uses the service said that they found the service to be �extremely good.�

People who use the service, their relatives and the staff all said they felt that they had sufficient time to carry out the tasks required and did not feel rushed or pressurised.

The manager and a person that used the service told us if there were any incompatibilities between the staff and the person, they would immediately replace the staff member with someone who was more compatible.

Inspection carried out on 11 January 2012

During a routine inspection

People told us that before the agency started to provide them with a service a nurse consultant visited them. This was to discuss the level of support they required. They said that they were given information about the agency in the form of a booklet.

People said that they had a care plan which they and/or a family member were involved in developing.

People told us that they felt safe and comfortable with staff looking after them. They described their relationship with staff as good.

People said that staff were respectful, helpful, trust worthy and caring. They said that staff were kind and respected their privacy and dignity.

People told us that the agency provided staff with the appropriate training to meet their needs.

People said that they were asked to complete an annual survey. One person said that the agency was open to suggestions and was transparent.

People told us that they had been provided with a copy of the agency�s complaints procedure. They were aware of whom to speak to if they had to make a complaint.