The Phoenix

The Phoenix is a residential care home providing personal care to up to a maximum of 6 people. The service provides support to people living with learning disabilities and/or autism in one adapted building. At the time of our inspection there were 5 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

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

People received their medicines safely and had access to appropriate health and social care support.

Support plans were person-centred and reflected people’s views and wishes.

People were supported to maintain meaningful relationships with people who mattered to them.

Right Care

Support was personalised and promoted people’s individuality and human rights.

Staff were trained and understood how to support to people to stay safe from harm or abuse.

There were enough appropriately skilled staff to meet people’s needs.

Right Culture

The values and attitudes of managers and staff supported people to live inclusive and empowered lifestyles. Staff promoted equality and diversity when supporting people.

There were systems in place to monitor the quality of the services provided and a culture of improvement had become embedded in the service.

People and staff had opportunities to give feedback about the service and contribute their thoughts and ideas for improvement. They felt listened to and were confident that any issues would be resolved.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 31 October 2022) and there were breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 31 October 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service on 16 August 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, need for consent, safeguarding service users from abuse and improper treatment and staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to good. This is based on the findings at this inspection.

You can read the report from our last inspection, by selecting the ‘all reports’ link for The Phoenix on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Phoenix is a residential care home providing personal care to up to maximum of six people. The service provides support to people living with learning disabilities and autism. At the time of our inspection there were six people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right support

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests.

Care records we reviewed stated people living at the service did not always feel safe, due to other people being distressed. Incidents and accidents were not always effectively recorded. There were inconsistencies in people’s care records when incidents had occurred, making the monitoring and management oversight of incidents ineffective. Senior management were developing systems to improve this process. Since the inspection these new processes have been implemented.

Risks associated with people’s care needs were not always identified and acted on in a timely manner. Risk assessments and care records were not always updated effectively. The management team had identified issues with risk assessments prior to the inspection and were working on an action plan.

People’s medicines were not managed safely in line with national guidance. Medicine administration records (MARs) did not always give staff the information needed regarding the route in which medicines should be administered. Information on how people would like to receive their medicines was not detailed or personalised. The management team said that they would act on our findings and changes would be made to the MARs on the next medicine’s cycle, this would be achieved with support from the GP and pharmacy.

Areas of the home needed maintenance. An outside decking area needed repair which mean people could not use the outside space. Cleaning schedules had not been completed by staff. Areas of the home required cleaning. Staff did not always wear face masks in accordance with government guidance.

Right Care

People’s care records did not always promote their care being delivered in a person-centred way. There were improvements needed to the language used in people’s care records to ensure they were treated with respect and dignity.

People’s care records did not always reflect their needs and wishes. The management team had identified issues with care plans prior to the inspection and were working on an action plan.

We observed staff interacting with people in a kind and caring manor.

Right Culture

The COVID 19 pandemic had a negative impact on staffing and the provider continued to work to address this. They had worked to restructure the service to ensure people were supported by staff who knew and understood them well. They were responsive, supporting people's aspirations to live a quality life of their choosing.

Although there had been many anonymous whistle blowers about the service. Concerns were investigated by the provider and their quality monitoring team.

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 01 January 2020)

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support Right care Right culture. The inspection was prompted in part due to concerns received about allegations of abuse, staffing and management culture. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Phoenix on our website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, deployment of staff, how the service gains consent when people do not have capacity to make decisions, ensuring DoLs applications are applied for and good governance at this inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Phoenix is a care home providing personal care and accommodation for up to six

people, some of who may be living with learning disabilities and autism. At the time of the inspection four

people were living at the service.

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

People and staff told us they felt the service was safe. There were effective systems and processes designed to protect people from abuse. Accidents and incidents were recorded and monitored so that further risk could be reduced. Risks associated with people’s care had been identified and managed. Appropriate checks had been sought prior to employment, so that so far as possible only staff with the right skills and characteristics were employed. There was enough staff to meet people’s needs. Risk of infection for people were effectively managed and reduced.

People’s needs were assessed prior to admission. Staff received an induction and on-going training. Staff supported people to maintain a balanced diet. Staff worked with other agencies to provide timely care for people. The premises were fit for purpose. People’s capacity to make decisions had been assessed.

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

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

Staff interacted positively with people. People’s privacy and dignity was protected. People were treated with kindness.

People had person-centred care plans in place. People were encouraged to communicate in a variety of ways. Information was accessible to people. People were supported to join in leisure activities. Complaints and concerns were recorded and acted upon. Some people had end of life care plans in place.

The service was open and inclusive. There was systems and processes to effectively monitor quality. The registered provider was committed to improve quality assurance. People and staff were encouraged to share their feedback. The service worked with other agencies to enable good outcomes for people.

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

This service was registered with us on 14 November 2018 and this is their first inspection.

Why we inspected

This was a planned inspection as per our inspection programme.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.