About the service:

Phoenix House is a care home that provides personal, but not nursing care and individual support to adults who have a primary diagnosis of a learning disability. Phoenix House can accommodate up to 11 people. At this inspection 11 people were living there.

Rating at last inspection: Good (2 April 2016). Currently rated as ‘requires improvement’ overall.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At this inspection we found concerns with the service provided, including breaches of the health and social care act, and rated the service as ‘requires improvement.’

People’s experience of using this service:

People did not always receive safe care and support. Individuals did not have comprehensive risk assessments that reflected their needs. Risk assessments were out of date and in some instances, had not been reviewed for several years.

Risk assessments had not been updated following significant incidents involving people. People did not have support plans, regarding their medicines, and there was no guidance to staff about when people should be administered ‘as needed’ medicines. Medicines were not stored safely.

People did not always have their rights protected by those supporting them as the provider and registered manager had not followed current guidance aimed at protecting people. The provider did not have effective care and support planning processes in place to assess people’s individual needs.

People did not have holistic assessments of their protected characteristics and were not supported to maintain their own identities. People were not always supported or included in making decisions which affected them.

People were not involved in the development of their care and support plans. The care and support plans in place did not reflect people’s current or changing needs and were not regularly reviewed.

The registered manager and provider did not understand the responsibilities of their registration with us. The registered manager and provider had failed to display the rating following the previous inspection as required by law. The registered manager and provider failed to make notifications to the care quality commission.

People were safe from the risk of ill-treatment and abuse as staff members had received training and knew what to do to keep people safe. The provider followed safe recruitment checks. People were supported to eat and drink enough to maintain their health.

Enforcement:

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

We will re-inspect Phoenix House within our published timescales to see what improvements have been made.

This inspection took place on 3 February 2016 and was unannounced. Phoenix House provides accommodation and personal care for up to 11 people who have a learning disability. There were 11 people who were living at the home on the day of our visit.

There was a registered manager in place 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.

People lived in a safe environment as staff knew how to protect people from harm. We found that staff recognised signs of abuse and knew how to report this. Staff made sure risk assessments were in place and took actions to minimise risks without taking away people’s right to make decisions.

There were sufficient staff on duty to meet people’s needs. People told us that staff helped them when they needed assistance. Reviews of people’s care happened when people’s care needs changed. Staffing levels were reviewed and reflected the needs of people who lived there and the flexibility of people’s daily routine. People’s medicines were administered and managed in a safe way.

People received care and support that was in-line with their needs and preferences. Staff provided people’s care in-line with their consent and agreement. Staff understood and recognised the importance of this. We found people were supported to eat a healthy balanced diet and with enough fluids to keep them healthy. People’s independence in food and drink preparation were promoted. We found that people had access to healthcare professionals, such as the chiropodist and their doctor when they required them and where supported to hospital appointments.

We saw that people were involved in the planning around their care. People’s views and decisions they had made about their care were listened and acted upon. People told us that staff treated them kindly, with dignity and their privacy was respected.

We found that people knew how to complain and felt comfortable to do this should they feel they needed to. We looked at the providers complaints over the last 12 months and found that no complaints had been received.

The registered manager demonstrated clear leadership. Staff were supported to carry out their roles and responsibilities effectively, which meant that people’s received care and support in-line with their needs and wishes.

We found that the checks the registered manager completed focused upon the experiences people received. Where areas for improvement were identified, systems were in place to improve the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The summary is based on the people we spoke with who used the service, the staff who supported them and from looking at records.

At the time of our inspection 11 people lived at the home. We met six people who lived in the home, five of those people we were able to speak with. We spoke with four relatives and a person from an organistation that spends one to one time with a person who lived at the home. We spoke with three members of staff, the registered manager and the provider.

Is the service safe?

People told us they felt safe with the staff that cared for them. There were procedures in place to keep people safe. Staff understood how to safeguard the people they supported.

People were protected against the risks associated with medicines because the provider had made improvements following out last inspection in November 2013. There were now appropriate arrangements in place to manage medicines.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. This meant that people would be safeguarded as required.

Is the service effective?

Relatives told us that they were able to see people who lived in the home in private and that visiting times were flexible. They also told us the staff were accommodating and welcoming to visitors.

It was clear from speaking with staff that they had a good understanding of the people’s care and support needs and that they knew them well. Staff spoke about people as individuals and we observed that staff listened to people’s views and opinions and acted upon them.

The registered manager told us they were in the process of organising refresher training for staff. This included training such as, infection control and manual handling.

The registered manager was updating the care records which ensured they reflected people’s care needs in detail. The registered manager told us that they were dedicating time to enable them to complete this.

Is the service caring?

We asked people for their opinions about the staff that supported them. What people told us was positive, one person said, “All the staff are lovely”. A relative told us, “They (staff) are always so cheery and smiley”.

People were supported by staff who demonstrated a clear understanding of their needs and preferences. People were treated with respect and dignity by the staff on duty. When we spoke with staff it was clear that they genuinely cared for the people they supported.

We looked at people’s preferences and interests and found that care and support had been provided in accordance with people’s wishes. We saw that the care people received reflected what we read in their care records.

Is the service responsive?

The registered manager was responsive to people’s needs. We saw examples where people were supported to attend hospital appointments when they were required.

People completed a range of activities within the service. People told us they were supported by staff with activities that they enjoyed.

Is the service well-led?

Staff told us the registered manager listened to them. Staff were clear about their roles and responsibilities. This meant that the registered manager listened to staff views and acted upon them where appropriate.

The registered manager told us that they had sent out questionnaires to the people who lived in the home and their relatives. Where comments had been made these had been acted upon. This meant that the provider had taken appropriate steps to gather people’s views of the running the home and had acted upon them.

The provider had quality assurance systems in place. We saw records that identified shortfalls and the actions that had been taken to address them.

When we visited Phoenix House we found that eleven people used the service and we met and spoke with two of these people. We spoke with two members of staff who provided care and the registered manager. We read the care records for three people who used the service. We observed care practice and staff interactions with people when they were delivering care.

We found that staff had an understanding of the needs of the people who used the service. We found that care and support was planned and delivered in a safe way, in line with people's individual care needs. One person who used the service told us, "I like it here, I go to work on the farm."

We found that systems were in place to deal with complaints. We found that the home worked well with other services to ensure the health and wellbeing of the people who used the service.

We found that the provider did not have systems in place to gain the consent to care and treatment of people who used the service.

We found that people were not protected from the risks of inadequate nutrition and dehydration.

We spoke with three out of the eleven people who lived at the home. All of the people we spoke with told us that they liked living there. One person said, "I like the staff. They are good to us. All the staff are nice to us." Another said, It's nice and friendly here."

The people that we spoke with told us that they felt listened to. One person said, "We have residents' meetings. We had one the week before last. We discussed the menu."

People told us that they were encouraged and supported to do things for themselves but were also given choices. One person said, "I wash my own hair and clean my own teeth. We use the washing machine and I also wash up. We clean our toilet." Another person said, " I choose not to do washing up," while a third person said, "I wash up all the cups and dry them. I take my sheet off my bed and I wash up. I do a lot of work here. I tidy up."

We found that people who lived at the home felt safe and that staff had received training in safeguarding, knew how to raise concerns and felt they would be supported by the provider if they did raise concerns. Staff had also been trained in areas relevant to the specific needs of the people they were providing care to. We looked at care plans for three people living in the home and found that these contained detailed guidance for staff on how to meet their needs.

We also looked at records which showed that the provider was regularly monitoring the quality of its service.

We did not speak to people who use the service directly during this inspection.

We followed up concerns we had raised in our last inspection. We found that people were not being supported in making choices and improvements were needed. We found during our inspection this time that there is still much work the service will need to do, in order to make sure people are being offered choices about their care and treatment.

We remain concerned about the staffing levels in the home. There are insufficient staff on duty to meet the needs of all the people living there. Improvements were still needed.

We also looked at the systems in place for the assessment and monitoring of quality within the service. We found that further improvements are needed.

People told us they were happy living in the home. They said they are given opportunity to go out and had recently been on holiday.

There were 11 people using services at Phoenix House when we visited. We met and introduced ourselves to all the people using the provider’s services over the two days we visited. We spoke to four people using services in more depth to get their views of the service. People told us, “I was alright coming to live here.” and “I like it here because it’s’ nice and big.”

People told us about their care plans and how staff supported them. One person told us, “I like being here, I feel safe.” Another person told us how staff kept them safe should they fall when not well. People we spoke with told us they were happy living at Phoenix House and liked the staff.

We asked people what they did during the day and they told us about shopping trips and going on holiday. One person told us “I love going on holiday with Phoenix House.” Another person said,” I love the dinners here.” One person however told us, “ We don’t do much at weekends.”

We spoke with one person who was living in the annex at Phoenix House which offered them more independence. They told us, “ I like living in this house but I like company so I have my meals at Phoenix House.”

People told us about seeing their GP and dentist and having other regular health care checks. We saw that one person attended their doctor’s appointment at the surgery independently, they told us they were happy to do this.

Relatives we spoke with had no concerns about the care of their family member. One relative told us, “name calls Phoenix House her ‘second home’.” Another relative told us, “They go out of their way to make things good for him.” Relatives told us that staff had worked hard to make things better for their family members. One relative told us, “I cannot think of a single fault with the home.”