About the service:

Phoenix House is a care home providing personal care and support for people with learning disabilities and complex needs. The care home is registered for nine people. At the time of this inspection there were five people using the service. Each person lived in their own self-contained flat.

The care service had been developed and designed in line with the values that underpin the Registering 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.

People’s experience of using this service:

People were protected from avoidable harm and abuse.

People’s risks were assessed, and plans were in place to minimise the risks.

Staff were recruited safely and were supported to carry out their role with training, supervision and appraisals.

People’s care needs were assessed before they began to use the service to ensure the appropriate support could be given.

People were supported with their healthcare needs and their medicines were managed safely.

The service involved relatives in decisions about the care.

Care was planned to maximise the choice and control people had over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff knew how to provide an equitable service.

People received personalised care which included their preferences and outcomes.

Staff and relatives gave positive feedback about the management of the service.

A variety of quality checks were carried out to identify areas for improvement.

We made two recommendations around record-keeping and medicine audits.

Rating at last inspection:

Requires Improvement (report published on 08 June 2018).

Why we inspected:

This was a scheduled inspection based on the previous rating.

Follow up:

We will continue to monitor the service through the information we receive.

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

The inspection took place on 28 February 2018 and was unannounced. At our last inspection in January 2017 we found a breach of the legal regulations . This was because not all staff had received autism training, including staff with no previous experience of working with people with autism. At this inspection, we again found that not all staff had completed training in autism upon commencing employment.

The service provides residential care for up to nine adults who have learning or physical disabilities. At the time of our inspection there were seven people using the service. The care service has been developed and designed in line with the values that underpin the Registering 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.

The service had a registered manager. 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.

We found the provider was in breach of three regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. You can see what actions we have asked the provider to take at the end of the full version of this report.

The service was not consistently well led. There was not an effective system in place to monitor staff supervision and to support staff to receive training from suitable trainers that was relevant to their role.

People who required their medicine to be administered covertly had conflicting information in their care plan and staff were unclear about how covert medicine was supposed to be administered. In addition insulin records for one person were not accurately amended at the time changes were made.

Staff records did not demonstrate the service had followed safe recruitment practice and references were not obtained in line with the provider’s policy.

People’s health and support needs were not always being met and we received mixed feedback from people’s relatives in relation to this.

Not all staff had received training in the Mental Capacity Act (MCA) and staff understanding and how to apply it to their role was limited.

The service was not following good practice in terms of the prevention and control of infection or food hygiene and we have made recommendations in relation to this.

People had varying opinions on whether support workers were caring and whether people were well cared for.

People did not always know how to make a complaint and who to make it to and we have made a recommendation about this.

Policies and procedures were in place for whistleblowing and safeguarding, as well as policies in relation to equality and diversity, fire safety and medicines.

Referrals were made to healthcare professionals where necessary and people were supported to eat and drink enough in line with their preferences and needs.

Care plans contained personalised information about people’s needs and preferences, including their communication needs.

Quality assurance practices were taking place such as spot checks, but these were not always effective at highlighting issues and what actions to take as a result.

We found the provider was in breach of three regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The inspection took place on 27 and 28 January 2017 and was unannounced. The inspection team consisted of one inspector.

This was the first inspection of the service since it was registered with the Care Quality Commission. The service provides residential support for up to nine people with learning disabilities and mental health needs and has been operating since October 2016. There were two people using the service at the time of our inspection.

There was a registered manager at the service at the time of our inspection. 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.

During our inspection we found that staff induction was not robust or specific to the needs of people who used the service.

Care staff had knowledge of safeguarding adult’s and they told us what action they would take to raise an alert if they suspected abuse.

The service had robust risk assessments in place that were updated if any changes occurred.

Care staff supported people using the service with their medicines and records were kept and updated daily.

The service carried out criminal record checks and obtained references before employing care staff.

Staffing levels were meeting the needs of the people who used the service.

Care staff were aware of what to do in an emergency situation.

Care staff received regular supervision.

Staff demonstrated their knowledge of the Mental Capacity Act 2005 (MCA) and how they put the principles into practice.

People who used service were supported to eat a culturally relevant and varied diet in accordance with their preferences as detailed in their care plan. People who used the service were also supported by care staff to have access to health care professionals as and when needed.

The service was caring and we saw examples of this during our inspection. A relative of a person who used the service spoke highly of the carer workers and the service as a whole.

Care plans were detailed in explaining the likes and dislikes of the people who used the service as well as their communication needs.

The service carried out regular and robust quality assurance audits.

We found one breach of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.