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Inspection carried out on 9 January 2018

During a routine inspection

The inspection took place on 9 January and was announced. The inspection continued on 10 January and was again announced.

Phoenix is a service made up of five homes in a neighbourhood on a large community campus. It is based on the outskirts of Ringwood and provides care and support to people with learning disabilities. It is registered to provide personal care. At the time of the inspection the service was delivering personal care to 16 people.

This service provides care and support to people living in five supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Not everyone using Phoenix receives 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.

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.

Staff did not all receive training in areas specific to people they were supporting. This meant there was a risk that people would not receive support from staff with the skills to meet their needs. Staff supervisions did not take place regularly and annual appraisals were not completed.

This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 (Part 4). You can see what action we told the provider to take at the back of the full version of the report.

People were not always supported appropriately to understand and meet their personal relationship needs. This meant that people could be at risk of being put in vulnerable situations.

We have made a recommendation about people training on the subject of personal relationships.

Goals and aspirations discussed with people in their reviews were not always reflected in their care plans which meant that some goals were not always met.

Incident reporting systems were not always effective or investigated appropriately.

Robust governance and quality monitoring systems were not established or embedded within the service. This had resulted in some areas for improvement not being identified or actions put in place to address them.

Medicines were not always stored safely. This meant that people were at potential risk of receiving unsafe medicines. We discussed this with the management who told us they would address this.

Medicines were correctly recorded and only administered by staff that were trained to give medicines. Medicine Administration Records reviewed showed no gaps. This told us that people were receiving their medicines.

There was an infection control policy in place and regular cleaning took place in locations to prevent and control the risk of infection.

People’s independence was promoted and staff supported people to develop life skills. People told us that staff were kind and caring.

Personalised care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they chose to live their lives. Each person had a care file which also included guidelines to make sure staff supported people in a way they preferred. Risk management plans were completed, reviewed and mostly up to date.

People and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received safeguarding training. People were provided with information about how to keep safe and were asked their desired outcomes following any alert made.

People were supported with shopping, cooking and preparation of meals in their home. The training record showed that staff had attended food hygiene training.

People told us that staff were caring. During home visits we observed positive interactions between staff and people. This showed us that people felt comfortable with staff supporting them.

Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes, interests and communication needs. Information was available in various easy read and pictorial formats. This meant that people were supported by staff who knew them well.

People, staff and relatives were encouraged to feedback. We reviewed the findings from quality feedback questionnaires which had been sent to people and relatives and noted that it contained positive feedback.

There was an active system in place for recording complaints which captured the detail and evidenced steps taken to address them. We saw that there was one outstanding complaint which was being managed in line with the local policy. This demonstrated that the service was open to people’s comments and acted promptly when concerns were raised.

Staffing was delivered to a group of people in each house instead of being constructed to support individuals and medicines and care records were kept together in one centralised place like a care home setting. We found that this did not have a negative impact on people.

We have made a recommendation about good practice guidance on the subject the principles of Supported Living.

Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them.

People, relatives and staff felt that the service was well led. The management team encouraged an open working environment. People and staff alike were valued and worked within an organisation which ensured a positive culture was well established and inclusive. The management had good relationships with people and delivered support hours to them.

The service was aware of their responsibilities under the Health and Social Care Act 2008, Duty of Candour, that is, their duty to be honest and open about any accident or incident that had caused, or placed a person at risk of harm. They also understood their reporting responsibilities to CQC and other regulatory bodies and provided information in a timely way.