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Phoenix provides personal care to people living in their own houses and flats in the community. Phoenix were providing a service to 18 people at the time of our inspection. The service supports adults living with a learning disability and autism. Some people had complex behaviour needs.

People’s experience of using this service:

The service reflected the principles and values of Registering the Right Support. 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.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways:

• People’s independence was respected and promoted.

• People's support focused on them having opportunities to be part of their community, meet others and maintain existing relationships.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

• People received a consistent level of care from a team of regular care workers. There were enough staff employed to meet people's needs.

• Staff understood how to communicate with people effectively to ascertain and respect their wishes.

• Care plans provided staff with information about people’s preferences and ways in which staff could support people emotionally and with the activities they enjoyed.

• Safe recruitment practices were followed to protect people from unsuitable staff.

• People were protected from abuse and harassment

• People received appropriate support to take their medicines safely as and when required.

• The provider arranged training for staff that met the needs of people using the service. Staff competency was assessed which helped to ensure they were safe to work with people.

• The provider had ensured there was effective oversight and governance of the service. The registered manager worked alongside the trustees and chief executive of the service to ensure that any issues were managed and priorities in relation to the quality of support were identified and acted upon promptly.

The service met the characteristics of Good in all areas. Further information is in the full report.

Rating at last inspection: We last inspected Phoenix on 6 February 2018. At the last inspection the service was rated Requires Improvement (this report was published on 13 March 2018).

The overall rating for the service has improved from Requires Improvement to Good.

Why we inspected: We inspected this service as part of our ongoing Adult Social Care inspection programme. This was a planned inspection based on the previous Requires Improvement rating. We followed up on progress against agreed action plans, to address breaches in regulation found at our previous inspection. Previous CQC ratings and the time since the last inspection were also taken into consideration.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

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

This service also provides care and support to people living in a number of '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.

People using the service lived in ordinary flats across Cheltenham and Gloucester. They also lived in single ‘houses in multi-occupation’ shared by between three and four people. Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities. People had individualised support packages of care and there were sleep in arrangements for staff support overnight.

Phoenix has been developed and designed in line with the values that underpin the Registering the Right Support, Building the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There were two registered managers. One managed the day to day running of the service and the other was the Chief Executive Officer and Nominated Individual. 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.

This inspection took place on 6, 7 and 13 February 2018. At the last comprehensive inspection in January 2016 the service was rated as Good overall.

At this inspection we found the service was Requires Improvement. This is the first time the service has been rated Requires Improvement.

People’s medicines were not being managed safely. Medicine administration records had not been completed correctly, creams and liquids had not been labelled with the date of opening and there were no protocols in place for the administration of medicines to be given when needed. Quality assurance systems were not robust. They did not evidence how action had been taken to make improvements to the service or when actions had been completed, that these were being sustained. The registered managers had not notified the Care Quality Commission about safeguarding concerns and incidents of physical abuse between people sharing supported living accommodation.

People’s care and support was individualised, reflecting their personal preferences, lifestyle choices and routines important to them. Staff understood people well and knew how to support them when upset or anxious. People were treated with kindness and care and had positive relationships with staff. They were supported with dignity and respect. People were supported to access a range of activities and met with friends at day centres, social clubs and work placements. People’s health and wellbeing was promoted. Their dietary needs had been discussed with healthcare professionals when necessary and staff followed their guidance. People had access to social and healthcare professionals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were encouraged to make choices about their day to day lives. They were kept as safe as possible from harm. Hazards had been assessed and any risks minimised and strategies put in place to reduce the risk of injury. People living in supported living were helped to live in a safe environment. They also had equipment and technology to keep them safe, for example hoists, walking frames and sensor mats. Lessons were learnt by the provider from complaints, accidents and incidents to make improvements to prevent these issues reoccurring.

People’s feedback and the views of relatives and staff were sought to make improvements to their experience of the service. People were invited to attend an annual meeting to give feedback about their experiences and aspirations which was then presented to the board of trustees. A representative of the board of trustees visited people in supported living to assess the quality of care provided. The registered managers were aware of the challenges of maintaining an effective staff team and had reviewed the way in which staff were valued. Staff said they were “proud of the charity” and people said, “The carers are good, caring, reliable and kind.”

Providers are required, by law, to display their CQC rating to inform the public on how they are performing. The latest CQC rating was displayed in the service and these details were also on the provider's website.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009 (Part 4). You can see what action we told the provider to take at the back of the full version of the report.

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 and associated Regulations about how the service is run.

People received individualised care which reflected their personal preferences, aspirations and routines important to them. Their care records were developed with them to provide staff with clear step by step guidance about how they wished to be supported. Wherever possible people were encouraged to maintain their independence. Any hazards people faced were risk assessed promoting them to continue to do things for themselves as safely as possible. People’s changing needs were closely monitored and they were supported to access healthcare professionals to access equipment or treatment to maintain their health and well-being. People’s care was reviewed with them and their relatives to make sure it continued to reflect their current needs.

People were supported by a knowledgeable and skilled staff team who had access to a robust training programme. Training specific to people’s needs such as end of life training or dementia awareness was provided. Staff were supported in their roles and they were observed carrying out tasks to make sure they had the necessary skills. People said visit times suited them and staff always stayed for the correct length of time. Although there was a large team of staff people knew most of them and were reassured that new staff worked alongside experienced staff before providing their care. People felt safe with the care provided. Staff understood how to recognise abuse and knew about to raise concerns. Staff commented, “Staff recognise professional boundaries; staff are passionate about their work and the people we support.”

People’s feedback was sought as part of the quality assurance process. This was done in a variety of ways such as surveys, individual and group meetings, reviews of their care and events with the trustees of the board. Staff felt empowered to voice concerns and said they would be listened to. Improvements to the service had resulted from their feedback. The registered manager was open and accessible, listening and responding to people and staff, dealing with issues as they arose. She recognised the challenges of maintaining a stable staff team who she described as “excelling” in their roles and “going above and beyond”. The vision of the provider to provide “excellent” and “person centred care” was embraced by staff. A person told us, “It is a very good service, I like it”.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This inspection was completed by one inspector. They visited the office and visited people who use the service in their own homes. We also carried out telephone interviews with people who use the service and their relatives. This is a summary of what we found based on our observations, speaking with nine people who use the service, talking with six staff and looking at records.

Is the service safe?

People who use the service told us, "I feel safe", "I feel safe with all of them", "I am perfectly safe with them". One person said, "It is not to be taken lightly, when you have staff in your home. I feel more than safe." People could be confident because there were systems in place to deal with emergencies protecting people from the risk of harm. Risks associated with the service provided to people were identified and managed. Staff had a good understanding of how to support people safely. Accidents, incidents and near misses were analysed to ensure the appropriate action was taken to make sure people remained safe.

People were protected from abuse or the risk of abuse. The provider had taken reasonable steps to make sure people were safeguarded from potential harm. Staff had completed the appropriate training and had a good understanding of how to respect and uphold people's rights. Effective recruitment and selection procedures were in place to make sure people's needs were met by skilled and competent staff.

Is the service effective?

People were involved in the assessment of their needs. Their care plans were person centred and reflected their individual wishes, aspirations and preferences for the way they wanted their care delivered. Staff were supported to understand people's needs and had completed training with health professionals involved in people's care. New staff were supported to acquire the skills and knowledge they needed to support people.

Is the service caring?

A person told us, "Staff are very polite and respectful." A relative told us, "They support him to be independent. They are helping him a lot, giving him confidence." Another person told us, "They understand my needs." We observed staff supporting people sensitively and respectfully. They offered people choices about their care and gave them time to make decisions and to complete tasks independently.

People, and those that matter to them, were encouraged to make their views known about their care, treatment and support and these were respected. The provider's business plan noted future improvements based on the feedback from people and staff.

Is the service responsive?

People's care was regularly reviewed with them. They had the opportunity to express their views about the service provided and feedback was given about any action taken as a result. Care was provided which reflected people's cultural and spiritual beliefs and considered their disabilities. The agency worked closely with other social and health professionals when delivering a new service to make sure there was continuity of care.

People knew how to share their experiences or raise a concern or complaint and felt comfortable doing so. People said, "I have no problems. If I have a concern I talk with staff. They are direct and open", "I have no complaints".

Is the service well led?

Robust quality assurance systems were in place which included monthly visits by members of the board to meet with people who use the service. The registered manager also visited people to assess the quality of service being provided. Staff had support and development meetings to ensure they knew what was expected of them. Staff spoken with understood their responsibilities and were motivated and caring.