Phoenix House

Phoenix House is a residential care home providing personal care to seven people who are living with a learning disability at the time of the inspection.

Phoenix House accommodates seven people in one adapted building over two floors.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The service was not well managed, and the registered manager lacked oversight of staff training, recruitment processes, medicines management and there was not a system in place to monitor the quality of the service.

Risks had not all been identified and minimised to ensure people were kept safe. Staff had not received regular training to ensure their skills and practice was being kept up to date.

There were enough staff available to ensure people’s needs were met at all times. Staff had time to support people with their interests and activities.

Staff did not have clear guidance in place that detailed what medicines people were prescribed and to ensure they were administered in line with the prescriber’s instructions. We have made a recommendation to seek further guidance from National Institute of clinical Excellence (NICE) in managing medicines in care homes.

Care plans did not all provide enough guidance to ensure staff had the detail one how to provide care and support to people in line with their needs and choices. We have made a recommendation to seek further guidance from NICE on best practice.

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

Staff felt well supported although they had not received any refresher and up to date training.

Staff were caring in the way they supported people with their needs.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 4 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified three breaches in relation to medicine management, recruitment and good governance at this inspection.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a registered manager in the home. 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 registered manager of the home was also one of the registered providers.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good…

People received support to take their medicines safely. Staff knew how to keep people safe from harm, risks were clearly identified and actions to reduce these implemented. There were enough staff to keep people safe and meet their needs.

Staff were competent to carry out their roles effectively and received training that supported them to do so. People were supported to eat a choice of freshly prepared meals, and supported with special diets. People were able to access and receive healthcare, with support if needed.

People were able to be in control of their lives, and encouraged to be as independent as possible. People were able to make choices and supported to make decisions, they were free from restrictions and understood their rights.

Staff were kind and compassionate in the way they delivered support to people. People were treated with dignity and respect. They ensured that people were able to have visitors, and enabled people to maintain relationships with relatives and friends who did not live nearby.

People had busy and varied lives, and were supported to access a wide range of activities and hobbies that meant their leisure time was enjoyable. People were confident that they could raise concerns if they needed to, and share their views about how the home was being run.

Staff ensured that the home was well run. Staff were committed to the welfare of people living in the home. The registered provider ensured that a programme of refurbishment and investment in facilities was regularly reviewed. Staff regularly engaged with people to seek their view about how they wanted the home to be run, and the activities on offer. The registered manager ensured they kept links within the local community and were part of many regular events. People living in the home were able to participate in and facilitate these. People felt part of their community.

Further information is in the detailed findings below.

We saw there were different options offered to people at each meal time and that individual preferences were met. This was confirmed by one person who told us they had chosen to have the evening meal that was being prepared, rather than going out to have a meal.

Records and certificates regarding any servicing were retained and available on request. These were stored in a lockable room. The provider explained that records and care plans were to be fully reviewed.

We looked at care plans that clearly explained how the individual preferred to be supported. We saw information about the choices people living in the home had made. For example, one care plan had statements that began with 'I do not like' and 'I may enjoy', showing people were consulted. However, some paperwork was quite outdated making it difficult to find up to date information in some sections.

The medication records we saw were appropriately completed and up to date. The provider explained how some people using the service were supported to take their own medication as needed.

In the main, staffing hours were covered by the two providers who have supported three people in the home for many years. There were also two other part time staff who assisted when needed and provided one to one support. People told us they discussed any matters with a member of staff and they had always felt able to talk about any problems or worries.

Auditing the quality of the service was being assessed through daily discussions. We were told that previous questionnaires had been issued but very rarely provided comments about areas that required developing.