Background to this inspection
Updated
13 November 2020
The inspection We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection team This inspection team consisted of two inspectors, an assistant inspector, a specialist advisor in health and learning disabilities and an expert by experience. An expert by experience is someone who has experience of care related to this inspection setting.
Service and Service Type
Phoenix Lodge is a registered care home. People in care homes receive accommodation and nursing or personal care. CQC regulates both the premises and the care provided, both were looked at during this inspection.
There was a manager registered with the Care Quality Commission. A registered manager and provider are legally responsible for how the service is run and for the quality and safety of the care provided. However, shortly before this inspection the registered manager had moved into a senior external management role for the provider and a new manager was recently appointed at the service, not yet registered. Throughout this report they will be referred to as ‘the manager’.
Notice of inspection This inspection was unannounced. However, we did announce our arrival before entering the premises because we needed to check the current Covid-19 status for people and staff in the service and we wanted to be sure there would be people at home to speak with us.
What we did We looked at information we held about the service to help us plan the inspection. This included written notifications the provider had sent to us about any important events that happened at the service. We contacted local care commissioners who contract for people’s care and spoke with five social workers. On this occasion we did not ask for a Provider Information Return. This is information we ask the provider to send us; to give some key information about the service, what the service does well and any improvements they plan to make. However, we gave the manager and provider opportunity to provide us with related information to help inform our inspection.
During this inspection We spoke with four people receiving care at the service and 10 care staff, including three team leaders. We also spoke with the manager, an external senior manager and the nominated individual for the provid
Updated
13 November 2020
About the service
Phoenix Lodge is registered to provide accommodation and personal or nursing care for up to 16 people with a learning disability and/or autism across three dedicated houses. At the time of the inspection there were 16 people receiving care at the service.
People's experience of using the service and what we found
The provider did not fully ensure effective governance and oversight of the service for the quality and safety of people’s care and timely service improvement when needed.
Arrangements for staffing and risk management strategies to monitor, report and analyse people’s safety were not always sufficient to consistently ensure people achieved the best outcomes.
Staff knew how to recognise and report abuse but were not always confident to do so. When things had gone wrong, the incident reporting and review process did not always identify how to prevent the same thing happening again.
Staff generally understood people’s care needs, individual characteristics and daily living preferences, which they followed. People’s related care plans and their needs assessments were not always accurately maintained to fully inform people’s care. Some improvements actions were in progress to help rectify this.
The provider’s arrangements for people’s medicines and prevention and control of infection at the service helped to ensure people’s safety.
People were generally happy living at the service and relatives felt people were safe and comfortable there. Staff, people and relatives were often engaged and consulted to help inform or improve people’s care.
The provider worked in partnership with relevant authorities and external care professionals to help enhance and inform people’s care, independence and equipment needs.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, 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 providing support to people with a learning disability and/or autistic people.
The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. People had choice, control and independence and their privacy, dignity and human rights were promoted.
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 March 2019)
Why we inspected
We received concerns relating to people’s safety. This included staffing, safeguarding, risk management and incident reporting practices within the service. As a result, we carried out a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.
We have identified a breach of Regulation in relation to governance at this inspection.
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. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.