Phoenix House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Requires improvement: This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. At this assessment the rating has changed to Good: This meant people were safe and protected from avoidable harm.

The provider was previously in breach of legal regulations relating to safe care and treatment and recruitment of staff. Enough improvement had been made, and the provider was no longer in breach of these regulations.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety, investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Staff were confident about raising any concerns and the steps they would follow regarding whistleblowing. Systems and processes were in place to review and investigate incidents, measures were in place to mitigate risk from further occurring incidents.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. We spoke with family members who told us decisions had been communicated with them. One relative said, “Anything they [staff] call me, they tell me everything.” Staff told us and records showed that people had been referred to services when needed to maintain their health and well-being.One professional said, “Any communication I have with them [staff] via email / telephone is appropriate and they [staff] follow up with any advice / treatment needed.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. Staff we spoke with had received training and were knowledgeable about safeguarding. People told us they felt safe living at the service. One relative said, “[person] is definitely 100% safe”.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Positive Behaviour Plans (PBS) were clear and detailed about how to support people using the least restrictive practices, staff were trained in de-escalation techniques.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Redecoration and replacement of flooring in communal areas was underway, the environment was homely. Each person had a Personal Emergency Evacuation Plan (PEEP) which set out detailed instructions about the level of support a person would require to evacuate the building in the event of an emergency. The fire alarm system was tested weekly.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. We found on the site visit that records were missing from the personnel files; however, this was discussed with the registered manager. Following our site visit, the registered manager sent us evidence that records and files were updated. There was a stable staff team who knew people well. Throughout our visits we observed warm and affectionate interactions between people and staff. One staff member told us, “Staff morale is good, we all work together as a team.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. We found on the site visit that fridge temperatures were not always within the temperature ranges as set out on the Food Standards agency guidance. However, this was discussed with the registered manager. They responded to tell us they had implemented a system to check and record fridge temperatures and provided information about safe temperature ranges to guide staff. The service was clean and tidy in all areas. Staff had received training in infection prevention and control and had access to personal protective equipment to use when needed. One relative said, “I have seen them [staff] using PPE.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. People received their medicines on time, as prescribed and they were stored and administered following best practice guidance. Staff carried out checks on medicines supplies. We found that some counts of medicines were not correct. However, we were assured that this was an issue around timings of medicines checks being completed rather than medicines administration. Staff received training to understand about safe medicines management and had regular competency assessments. Audit systems were in place with oversight from the registered manager and were well managed.