The inspection took place on 27 and 28 November 2018. The inspection was unannounced.

Phoenix Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Phoenix Residential Care Home provides accommodation and support for up to 18 older people. There were 17 people living at the service at the time of our inspection. People had varying care needs. Some people were living with dementia and some had diabetes or were recovering from a stroke. Some people required support with their mobility around the home and others were able to walk around independently.

The registered manager was also the provider. 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.

At our last inspection on 10 October 2017, the service was rated as ‘Requires improvement. We found breaches of Regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to, the care planning and review system did not meet people’s needs and preferences; people’s medicines were not managed safely; monitoring systems did not identify shortfalls in quality and safety.

The registered manager sent us an action plan following the inspection, on 22 January 2018, detailing what they planned to do to make improvements, although the action plan did not confirm a date when they expected to be compliant by. At this inspection, the registered manager had followed their action plan and made improvements in some areas; people’s needs and preferences were identified through the care planning process. However, other parts of their action plan had not been completed as promised as, the management of people’s medicines needed to improve as they were still not safe; the monitoring of quality and safety continued to be ineffective and the management and leadership was in question as the service had failed to improve. We also found many other areas of concern.

Assessments had not always been carried out to identify risks to people’s safety and to put individual measures in place to protect them from harm. People whose behaviours challenged others were not always supported using a positive approach. Incidents of challenging behaviour were not recorded appropriately and not monitored to provide better outcomes for people. Safe infection control procedures were not always followed.

A strong odour was present during this inspection and the last inspection and had also been raised as a concern by relatives and others at various times. This had not been rectified.

Mental capacity assessments had not been carried out where a person’s capacity to make some decisions was in doubt. DoLS authorisations had been applied for and were either in progress or had been authorised by the local authority.

People had been referred to healthcare professionals when required. However, the advice given had not always been recorded within people’s care plans to make sure the advised treatment was followed correctly, such as their skin care and nutrition and hydration, which compromised their safety.

Staff had basic mandatory training but had not received specific training to make sure they had the knowledge and skills to meet people’s individual needs and tasks that were requested of them. Evidence was not available to show that the staff who delivered training had the necessary qualifications to do so.

People’s records had not always been accurately maintained to provide an up to date account of people’s care needs. End of life care plans did not always record t

The inspection took place on 10 October 2017. The inspection was unannounced.

Phoenix Residential Care Home is registered to provide accommodation and personal care without nursing for up to 18 people. There were 18 people living at the service at the time of our inspection.

People living in the service required care and support and had varying needs. Some people were living with dementia and some people had medical conditions such as diabetes or respiratory conditions and some people were recovering from suffering a stroke. Most people living in the service were mobile, some independently mobile and others needed the support of one or two staff. No people were unwell enough to be cared for in bed.

The service was set out over two floors in an old building on a busy main road into the town of Chatham. Bedrooms were available on the ground floor and the first floor. Most bedrooms, all except two, had an en-suite toilet. A passenger lift was available to take people between floors.

A registered manager was employed at the service. The registered manager was also one of the providers of the service. 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.

Phoenix Residential Care Home was last inspected on 30 August 2016. Two continuous breaches of legal requirements were found in relation to Regulations 11 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one other breach was found in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

After the inspection the provider sent us an action plan which detailed how they planned to address the breaches of Regulations. The action plan did not specify a date when they intended to be compliant by.

At this inspection we found that improvements had been made in all the areas of concern found at the last inspection. However, we found new concerns and improvements that were required in each of the five domains.

Some elements of how medicines administration was managed needed improvement. Prescribed thickeners to add to people’s drinks to prevent choking were not stored or administered safely. Medicines audits did not highlight concerns found. Guidance for staff when administering ‘as and when necessary’ medicines were not in place.

Staff did not keep consistent records of people’s care. Daily records were not always completed. Documents did not show if people had been referred to appropriate health care professionals. Care plans were in place but not always up to date or consistently capturing people’s care and support needs or preferences.

People’s hobbies, interests and life histories were not used to provide person centred care and meaningful activity to maintain well-being.

The registered manager had processes in place to undertake regular audits to check the quality and safety of the care provided. However, these audits were not robust. They did not identify concerns we had found during the inspection and did not always record who had completed the audit or the action required when areas for improvement were found.

People and some staff were not always confident about raising their concerns about the attitude of some members of staff. Staff felt they could talk openly about most areas and felt they were well supported generally.

Risk assessments were in place to protect people from the risks of harm. Accidents and incidents were documented, clearly recording the action taken. The registered manager reviewed all incidents to take action to prevent future occurrence.

The deputy manager had a young pet dog that was in the service each day to support their training in socialising with people. Appropriate sp

We previously carried out an unannounced comprehensive inspection of this service on 16 and 18 November 2015. Breaches of legal requirements were found. We took enforcement action and required the provider to make improvements to become compliant with Regulation 9, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, by 11 April 2016.

We undertook a focused inspection on 12 April 2016 to check the provider was meeting the regulations. At that inspection we found that some improvements had been made however the provider remained in breach of Regulation 9, 11, 17. A breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was also found during that inspection.

This inspection was carried out on 30 August 2016 and was unannounced. This was a comprehensive inspection and included an inspection of the previous breaches of legal requirements. The service provided accommodation and personal care for up to 18 older people some of whom were living with dementia. The accommodation is arranged over two floors. There is a lift to assist people to move between floors. There were 12 people living in the service when we inspected. At this inspection we found that improvements had been made, however, improvements were still required in a number of areas.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The provider was also the registered manager of the service. 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 received a service that was safe and they told us they felt safe. Systems were in place to protect people from the potential risk of abuse. Staff had access to an up to date safeguarding adults policy which included the action staff should take if they suspected abuse. Some staff had received training about protecting people from abuse; however, some staff were overdue the refresher course. Staff were able to describe the potential signs of abuse. Accidents and incidents involving people had been recorded, but these were not monitored to identify any potential patterns or trends that had developed. We have made a recommendation about this.

People received support and assistance from enough staff to meet their assessed needs. Recruitment practices were safe and checks were carried out to make sure staff were suitable to work with people who needed care and support. However, the provider had not ensured the full employment history for each member of staff had been recorded. We have made a recommendation about this.

Risks to people’s safety had been assessed and recorded with measures put into place to manage any hazards identified. The premises had been maintained to ensure the safety of people. However, checks of the fire alarm system had not been consistently completed. A fire risk assessment had been completed by an external auditor which had identified a number of actions which required completing to ensure the safety of people using the service.

People received their medicines safely and when they needed them. Policies and procedures were in place for the safe administration of medicines and staff had been trained to administer medicines safely. People were supported to remain as healthy as possible with the support of healthcare professionals.

Staff had not al

We carried out an unannounced comprehensive inspection of this service on 16 and 18 November 2015. Breaches of legal requirements were found. We took enforcement action and required the provider to make improvements to become compliant with Regulation 9, 13, 17 and 18 by 11 April 2016. The provider sent us an action plan which stated they would meet the regulations by 01 March 2016. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 9 (1) (a)(b)(c)(3)(a)(b)(c), Regulation 13 (1)(2)(3)(4)(a)(b)(5), Regulation 17 (1)(2)(a)(b)(c) and Regulation 18 (1)(2)(a).

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Phoenix Residential Care Home on our website at www.cqc.org.uk’.

The inspection was carried out on 12 April 2016. Our inspection was unannounced and there were 14 people living at the service. This was a focused inspection to follow up on actions we had asked the provider to take to improve the service people received. The provider sent us an action plan which stated that they would comply with the regulations by March 2016.

The service did not have a registered manager. The previous registered manager had ceased working at the service in August 2015. The provider had made an application to become the registered manager with the Care Quality Commission when we inspected.

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 2014 and associated Regulations about how the service is run.

At this inspection we found that some improvements had been made but the provider had not completed all the actions they told us they would take within the timescales they had given us. In particular they had not met the requirements of the warning notices we issued at our last inspection.

Systems were not in place to ensure people received their medicines as prescribed by their GP. People did not have their prescribed medicines for a period of up to two weeks, as a process was not in place for the ordering and receiving of people’s medicines. Medicines administration had not been recorded effectively.

Procedures had not been followed in relation to the Mental Capacity Act 2005. Some people had not been supported or a mental capacity assessment completed before decisions were made on their behalf. A mental capacity assessment determines if a person has the capacity to make specific decisions about their lives.

Staff received training relevant to their roles such as infection control and moving and handling. However, staff had not received training in first aid and Parkinson’s to enable them to safely support people. Staff felt supported in their role by the provider/manager.

Systems in place to review people’s care plans had not always been followed or completed. Records showed that people were not always offered the opportunity to have a bath or shower.

Processes were not followed to monitor and improve the quality of the service being provided to people. The provider had quality assurance systems in place but these had not been completed consistently to ensure the safety of people using the service.

Staff had undertaken safeguarding training and were aware of their role and responsibilities in relation to safeguarding people. Staff gave examples of the potential signs of abuse and who they would report any concerns to, such as, the local authority or the police. People told us they felt safe living at the service.

Assessments had taken place to ensure there were enough sta

The inspection was carried out on 16 and 18 November 2015 and was unannounced.

The service provided accommodation and personal care for up to 18 older people some of whom were living with dementia. The accommodation is arranged over two floors. There is a lift to assist people to move between floors. There were 14 people living in the service when we inspected.

The service did not have a registered manager. The previous registered manager had ceased working at the service in August 2015. There was an acting manager in place who advised us they were planning on applying to become the 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.

During this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not safeguarded against abuse or the risk of abuse. There were not enough staff to keep people safe and meet their needs. Staff were not adequately trained to meet people’s needs. People were not adequately protected from the risk of malnutrition and dehydration. People did not receive personalised care. People’s dignity was not always protected. People were not provided with activities which met their needs. Complaints were not dealt with in a timely manner. Quality assurance systems were not effective. Records were not accurate or maintained.

Some people made complimentary comments about the service they received. People told us they did feel safe and well looked after. However, our own observations and the records we looked at did not always match the positive descriptions people had given us. Some of the relatives we spoke with were happy with the service being provided and others we spoke with had raised concerns with the manager which they felt had not been dealt with. We had received a number of concerns from various sources prior to the inspection. These concerns were regarding lows levels of staffing, poor quality of food and small portions, lack of activities, staff training and a lack of healthcare products such as incontinence aids for people. These concerns were substantiated from our observation during our inspection.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. At the time of the inspection, the previous manager had applied for DoLS authorisations for some people living at the service. Staff however did not understand their responsibilities the procedures of the Deprivation of Liberty Safeguards and where unaware that some people had applications to have their liberty deprived. Procedures had not been followed in relation to the Mental Capacity Act 2005. People had not been supported to complete a mental capacity assessment before decisions were made on their behalf. A mental capacity assessment determines if a person has the capacity to make specific decisions about their lives.

Not all staff had received the essential training or updates required to meet people’s needs. This included training in the Mental Capacity Act 2005 (MCA) and preventing and managing behaviours that were a risk to the person or others.

People were not protected from the risk of abuse. Staff had not received training or guidance relating to the protection of vulnerable adults. Staff were unclear of the actions they should take if they identified or suspected abuse.

The provider did not have an effective system to check how many staff were required to meet people’s needs and to arrange for enough staff to be on duty at all times. Staff told us and we observed that there were not enough staff to meet people’s needs.

Safe recruitment procedures had not been followed to make sure staff were suitable to work with people. Two people had started working at the service before a Disclose and Baring Service (DBS) background check had been obtained. These checks ensure people were safe to work with vulnerable people.

People or their relatives were not involved in developing a care plan to meet their needs. People’s needs were not always assessed to ensure staff knew how to meet people’s needs. Potential risks to people’s safety and wellbeing had not been assessed or recorded.

People’s weights were not being monitored accurately to make sure they were getting the right amount to eat and drink, there was a risk of people experiencing malnutrition. There were mixed views about the meals, some people were complimentary but other people were surprised at the small amount of food they had been given. Advice from health care professionals had not always been sought in a prompt manner when people showed signs of illness.

Information regarding complaints was not easily accessible to people or their relatives. Complaints that had been raised had not been recorded. There was no system to make sure prompt action was taken and lessons were learned to improve the service being provided.

Quality assurance systems had not been effective in recognising shortfalls in the service. Improvements had not been made in response to accidents and incidents to ensure people’s safety and welfare. Records relating to people’s care and the management of the service were not well organised or adequately maintained.

People some of whom were living with dementia were not provided with meaningful activity programmes to promote their wellbeing. People were supported to maintain their relationships with people that mattered to them. Visitors were welcomed at the service at any reasonable time.

People received their medicines safely as prescribed by their GP.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

You can see what action we told the provider to take at the back of the full versions of this report.