Archived: Phoenix Care & Domiciliary Service Limited

Phoenix Care & Domiciliary Service Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to younger and older adults. Not everyone using the service receives support that is a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’, including help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of this inspection 28 people were receiving personal care from the service. People who use the service live in Torbay and the surrounding areas.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the previous inspection in November 2016, we identified concerns relating to systems for governance. The registered manager had not taken appropriate action after an allegation of abuse was made. We took enforcement action and issued the service with a warning notice. The service was rated ‘Requires Improvement’. Two of the key questions (is it safe and is it well-led) were rated ‘Requires Improvement’.

At this inspection, we found the registered manager had reviewed the safeguarding policy and procedures. When another allegation of abuse had been made, the registered manager had taken appropriate action and worked with the local safeguarding authority and police. They had also notified the CQC of the concerns. We found the service had taken sufficient action to meet the warning notice. The registered manager had taken guidance from a training and consultancy company to support them. A representative from the company was present for part of the inspection. They were working with the registered manager and planned to introduce further audits. We saw there were systems in place to monitor the service.

People were supported by a strong, stable staff team who knew them well and focused on ensuring they received the highest quality of care. Without exception, people and their relatives told us they were happy with the care they received. People said staff were kind and caring, and they were always treated with respect and dignity. Comments included “They’re nice and cheery, give a lot of care, and we have a laugh”, “They come in sit down and have a chat before they start, they’re interested” and “They are wonderful, I’ve got the best carers.” A community professional told us, “I’ve worked closely with them and always found them very good” and “they provide high quality care.” We found examples of where staff had gone over and above their responsibilities, in their own time, to support people and their families. For example, one person was in hospital. Their relative had previously planned a break away. The registered manager spoke with the relative and arranged to visit this person throughout their stay in hospital, ensuring they had everything they needed.

People told us they felt safe and comfortable when staff were in their home and when they received care. People were provided with a copy of the staff rota so they knew who was due to visit them. Staff knew how to recognise signs of potential abuse and understood how to report any concerns in line with the service's safeguarding policy.

Safe staff recruitment procedures were in place. This helped reduce the risk of the provider employing a person who may be unsuitable to work in care. People told us staff knew how to meet their needs. One person commented, “They do things exactly as I want them to.” Community professionals told us, “They take initiative, communicate well, provide thorough feedback and are quick to raise concerns.” Staff were happy with the training they received. They said they felt well supported and had regular opportunities to discuss their work.

Staff knew people well and were able to tell us how they supported people. Care plans were developed with each person. They described the support the person needed to manage their day to day health needs. People’s communication needs were met. The service was complying with the Accessible Information Standard (AIS). The AIS applies to people using the service who have information and communication needs relating to a disability, impairment or sensory loss.

People’s care plans identified their communication needs and contained details of how they communicated and how staff should communicate with them. This ensured people’s needs were met in the way they wanted. At the time of our inspection, one person did not have capacity to make decisions relating to their care. Their relative had a power of attorney to enable them to make decisions relating to their relation’s care. Staff told us they gained consent from people before carrying out personal care and respected people's choices. People confirmed this happened.

Risks had been assessed for each person and were safely managed. Risk assessments had been carried out in relation to falls, epilepsy, skin care, and mobility. Risk assessments relating to each person's home environment had been completed. Where concerns were identified, action had been taken to reduce the risks to people. People were supported safely with their medicines and told us they were happy with the support they received. Staff completed medication administration record (MAR) sheets after giving people their medicines. The MAR sheets were audited to ensure people had received their medicines as prescribed to promote good health.

The service sought regular feedback. People told us they were asked for feedback over the phone, during visits and care plan reviews. People and their relatives felt able to raise concerns or make a complaint. They were confident their concerns would be taken seriously. People told us they didn't have any complaints. Comments included, "I’ve got no worries” and “I couldn’t fault them in any way.”

People told us the management were approachable and they were very happy with the service. People told us, “They’ve been very good, if I’m stuck I can ring them”; “I wouldn’t have managed without them” and “very good communication.” Staff said, “I’m very happy, you only have to phone and we can talk things through” and “It’s lovely.”

The registered manager was keen to develop and improve the service. The registered manager attended local provider forums and accessed professional websites. This meant they kept up-to-date with good practice and knew what was happening in the care profession. They had devised a set of questionnaires linked to CQC’s key questions; is the service safe, effective, caring, responsive and well-led. These asked staff to consider what was happening for people and to identify improvements. The registered manager had worked in partnership with healthcare professionals to ensure ‘joined up’ care was delivered to people. This meant people benefited from high quality care and improved outcomes. Records were well organised and up-to-date. An audit system was in place to monitor the quality of the service. Checks to observe staff's competency were carried out on a regular basis.

Inspection reports are produced in different formats, such as easy read, audio or large print and are available upon request.

There was a registered manager 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.

At our previous comprehensive inspection in September 2015, we identified concerns relating to staff recruitment, training and support. Medicines were not always managed safely. Records were not well maintained and systems for governance and monitoring quality were not robust. The service was rated 'Requires Improvement'. Four of the five key questions (safe, effective, responsive and well-led) were rated ‘Requires improvement’.

At this inspection we found improvements had been made. However, systems for governance were still not effective. The lack of oversight and good governance placed people at potential risk of harm. We identified a shortfall relating to the management and reporting of safeguarding concerns. We found allegations of abuse had been made. The registered manager had not taken action as instructed and investigated these concerns in a timely way. The registered manager told us there hadn’t been any safeguarding incidents, although they had been made aware of concerns a week before our inspection. A safeguarding meeting took place the day after our inspection started and the registered manager advised us the following day. We asked the registered manager why they had not mentioned this incident. They told us it was because there was so much happening and staff at the local authority had told them not to tell anyone. This is a notifiable incident that must be reported to the Care Quality Commission without delay. Staff had a good understanding of safeguarding and knew how to recognise signs of potential abuse. However, some staff did not know who they could contact outside of the service. The registered manager told us they would attach the contact details to staff’s next pay slip.

Processes in place for staff to account for decisions, actions, behaviours and performance were not always clear. The company director delivered care to people in their homes. They told us the registered manager supervised their practice. The company director had responsibility for overseeing and supporting the registered manager and the governance systems. This posed a conflict of interest. We discussed this with the registered manager. They told us they worked with another agency, who were independent of the service, and they would look into the possibility of supervision being supported by them.

People were happy with the staff who visited them. Comments included "I’m always pleased to see them come”; “Excellent, respectful, kind and nice; we have a chat” and “”They’re fantastic”. Healthcare professionals told us they found the care staff to be caring and helpful. People told us they had a small team of regular staff who they knew well. Several people gave us examples of staff going above and beyond. For example, one person had recently been in hospital. Staff had visited the person in their own time and checked whether they could get anything for them and their relatives. Where people were receiving end of life care, the registered manager ensured there was a team of trained, regular care staff. The service had worked with ‘hospice at home’ to help support people who wished to remain at home.

People told us staff knew how to meet their needs. People said "They know what they’re doing and they know how to use the equipment” and “They’re marvellous, they know how to meet my needs”. A relative told us staff had given them tips on how to make it easier for them to support their loved one. All the staff we spoke with told us they felt well supported. Some staff told us they regularly worked with the registered manager. Staff told us they had regular supervisions with the registered manager to discuss their work.

Recruitment practices were safe. Staff files included evidence that pre-employment checks had been made. This helped reduce the risk of the provider employing a person who may be a risk to people.

The service had enough staff to carry out people's visits and keep them safe. People told us staff were usually on time and had time to meet their needs in the way they wanted.

Risk assessments had been undertaken for each person. These included information about action to be taken to minimise the chance of harm occurring to people. We saw risk assessments had been carried out in relation to mobility, behaviours, epilepsy, nutrition, and skin care. Risk assessments relating to each person's home environment had been completed. People were supported safely with their medicines and told us they were happy with the support they received.

People's needs were assessed and care plans were developed with the person. Care plans described the support the person needed to manage their day to day care and health needs. The registered manager had introduced person centred care plans. These contained information on the person’s history, interests and preferences. Staff knew people well and were able to tell us how they supported people.

People and their relatives felt able to raise concerns or make a complaint. They were confident their concerns would be taken seriously. People told us they didn't have any complaints. Comments included "No complaints at all" and "I can’t fault them”.

Records were clear, well organised and up to date. An audit system was in place to monitor the quality of the service people received. Unannounced checks to observe staff's competency were carried out on a regular basis. The service sought regular feedback. People told us they were asked for feedback over the phone, during visits and through questionnaires. A survey had been carried out in October 2016. The majority of the responses showed ratings of good, very good, or excellent. There was a suggestion for improvement in relation to letting people know if staff were going to be late. The registered manager had reminded staff to make sure they contacted the office or the person. Staff told us they rang people if staff were going to be late, and the majority of people confirmed this happened.

We found three breaches of Regulations. You can see what action we told the provider to take at the back of the full version of the report.

We talked with four people who used the service, two staff and the manager. People told us they felt their needs were met by trained and knowledgeable care staff. One person said 'They (the care staff) know exactly what needs doing and they help me out to no end'. Another person said 'Without their support I would not be able to stay at home'.

We found that the staff had received training, supervision and appraisal since our last inspection. All staff had completed training or were booked to attend training within the next month. Care staff told us how training helped them to improve their skills and knowledge, which had helped them to give the best possible care and support to people.

Quality assurance systems had been significantly improved. The service had sent out questionnaires to people who used the service and most had been returned. The comments were positive. The manager had completed and recorded spot checks to monitor quality of care being provided by care staff.

We talked with six people who used the service, four staff and the manager. People told us staff treated them with respect and listened. Staff gave examples of how they respected people's privacy and dignity, and gave people choices.

We asked people if they had the same care staff regularly. People told us they received a list every week so they knew who would be visiting them. Four people we spoke with told us that they usually had the same staff. Two people told us there could be different staff but they were happy with this.

People we spoke with told us they felt safe. Staff told us about different types of abuse and what they would do if they suspected abuse. The service had updated their safeguarding policy.

We found that the staff had not received current training, supervision or appraisal. Staff this and the manager told us 'I have let training lapse.' and 'I have not done appraisals or supervision'.

Quality assurance systems had not been improved since our last inspection. However the service had completed 29 questionnaires of service users.