Phoenix Care Wakefield

Phoenix Care Wakefield is a domiciliary care service, which provides personal care for adults who live in their own homes. The home care service is based in Wakefield, West Yorkshire. Not everyone using Phoenix Care received a regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. The service currently supports 62 people in the community receiving a regulated activity.

At our last inspection in May 2017 we rated the service ‘requires improvement’. We found three breaches of regulation. Following the inspection, the registered provider sent us an action plan detailing the improvements the planned to make. At this inspection we found the improvements had been made and the previous breaches of regulation satisfied. We have rated Phoenix Care Wakefield as ‘good’.

At the time of our 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.

People felt safe, happy and supported by staff from Phoenix Care. People were very happy with the service and the support they received. They had confidence in the staff who supported them. They told us staff were familiar to them and knew them well.

Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally.

Safe and effective recruitment practices were followed to help ensure all staff were suitably qualified and experienced. Arrangements were in place to ensure there were sufficient numbers of staff available to meet people's individual needs.

There were plans in place to help staff understand and meet people`s needs. Staff were trained and their competencies were assessed in the areas where people required support. This included personal care, moving and handling and medicine administration. Staff had regular supervision with their line manager to ensure their development and performance was reviewed and support was in place for them to understand their roles and responsibilities.

Staff understood how consent should be considered in line with the Mental Capacity Act 2005. The registered manager understood the requirements of the law and what action to take if they became concerned about a person's ability to make decisions for themselves.

Staff understood people's dietary requirements and people were offered choices in the meals and drinks staff prepared for them.

People were involved in planning their care and determining how they wished to receive support. They spoke highly of the care they received and of how staff would assist them with additional tasks if necessary. People's care was reviewed and updated in line with their needs and wishes. Where people could benefit from additional support, referrals were made to other healthcare professionals.

People and relatives told us they thought the service was well managed. People felt able to contact the management team or staff if they had concerns and said they received a quick response.

Systems had been implemented so that the quality of service provided could be closely monitored, to ensure people were receiving the care and support they required. These were in the form of audits and surveys. Records showed that people had been asked for their views about the service.

Phoenix Care Wakefield was previously inspected in January 2014, and was meeting the Regulations. At this inspection we found the care records were not person centred and lacked detail regarding how a person’s needs were to be met. There were some weaknesses in the management of medicines. We also found the provider’s recruitment process was not a sufficiently robust process to ensure staff were of good character. The provider had not assured themselves that all checks were complete and satisfactory prior to letting staff deliver care. We established the provider did not have sufficient systems in place to assess and monitor the quality of the provision. We concluded these issues collectively constituted breaches of Regulations 12, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was a registered manager in post. 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.

We spoke with six people who used the service and three relatives. Everyone we spoke with were very happy with the service provided. People told us the registered manager was approachable and dealt with any issues they had. They told us the registered manager had visited them prior to agreeing the care package and listened to what they wanted.

We found the care records were not person centred and lacked detail regarding how a person’s needs were to be met. For example, the care records were written in the third person and had a check list to show the carer what was required for each call. This was task orientated. For example; ‘assist [person] out of bed and to standing position.’ Where people had diabetes, there was no diabetic protocol in place to provide information to staff about the signs and symptoms of hypoglycaemia and hyperglycaemia and what action staff should take in response to this.

Staff knew people well and staff had a regular client group, although there was a risk that if the documentation lacked detail people’s needs may be overlooked in the event of staff sickness or new staff joining the organisation.

Staff confirmed they had received medicines training. They were aware of their responsibilities in relation to checking the person received the right medicine, in the right dose and at the right time. However, we found some weaknesses in the management of medicines. For example, the Medicine Administration Records (MARs) did not document which individual medicines had been given. It was therefore not clear whether all the required medicines had been given and whether any PRN (‘as required’) medicines had been administered. We also found on one person’s MAR it showed they were required to take a number of medicines at lunch and tea time. However, there were gaps on the MAR for more than seven days when it was not documented whether the person had received their medicines.

The provider’s recruitment process was not a sufficiently robust process to ensure staff were of good character. The provider had not assured themselves that all checks were complete and satisfactory prior to letting staff deliver care.

There was evidence of staff induction and training and we saw training certificates in staff files. Staff completed the Care Certificate and we saw evidence of training undertaken in staff’s individual workbooks. Training was mostly done online although there were practical elements where necessary, such as first aid and moving and handling. Records showed staff received regular supervision and staff said they felt supported in their role. The provider maintained an overview of supervision on a matrix which showed the last supervision date and the next one due. Records of staff supervision were kept on staff’s individual files and there were action points discussed, agreed and recorded.

Staff understood the basic principles of the Mental Capacity Act (2005). People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff members understood the importance of respecting choices people made, and people’s right to refuse care and support. One staff member told us; “I give people choices and explain why care is needed.” Another told us; “I encourage people to do what they can for themselves.” We found evidence to show people had been involved with their care. For example, people told us the registered manager had visited them prior to agreeing the care package and listened to what they wanted. We saw initial assessments in people’s care records prior to care being delivered.

There was strong evidence staff worked closely with other professionals to ensure consistency of care. Records showed staff attended meetings to review people’s care when necessary. For example, staff attended a meeting regarding one of the children the service provided care for and this included family members, teaching staff, health professionals and social workers.

The provider gave details of their complaint and compliments policy in the service user handbook. This also provided details of external agencies a person could raise complaints or concerns with.

The provider was not always aware of the statutory notifications they needed to submit to the CQC. We found they had failed to notify us of two medication errors. The registered manager gave assurances they would look into this immediately and ensure they were fully aware of their legal duties.

We found the provider did not have sufficient systems in place to assess and monitor the quality of the service. For example, the provider carried out the MAR audits but had not considered whether specialist advice would benefit the process, such as from a pharmacist. Also the registered manager and provider were on occasions auditing their own work, such as recruitment paperwork. This meant it was difficult for them to identify shortfalls and areas where improvement could be made. Accidents and incidents were recorded individually, but there was no overview of these to establish if patterns or trends occurred.

The provider said they valued their staff highly and we saw evidence on staff newsletters they had been thanked for their hard work and professionalism. Staff told us they thought the service was run well and they felt valued by the management team. One member of staff told us; “If you have a query you can go to them [the management]. There’s always someone to talk to.” Another member of staff said; “There is a very good support unit. They go above and beyond.”

You can see what action we told the provider to take at the back of the full version of the report.