Archived: Phoenix Care Services Ltd

Phoenix Care Services Ltd (Phoenix) is a domiciliary care agency providing personal care to people living in the local area. The service provides support to older and younger adults who live with physical, health and mental health related support and care needs. At the time of the inspection there were 8 people using the service.

People’s experience of using this service and what we found

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

People were supported to remain safe and well and according to their individual wishes, preference and needs. People told us they felt safe with staff. There were enough trained staff to provide care to people. Staff were able to provide safe support to people around their individual risks, needs and medicines. New staff were recruited safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were complimented by people and their relatives for their caring, compassionate and kind attitudes. One person said, “[Staff] talk as we go along and check if I am happy, if I am honest, they take all my troubles. I tell them and they cheer me up.” People felt respected, listened to and involved in their care. People knew how to raise complaints and concerns and felt communication with the management team was good.

People’s care was planned in a personalised way, involving them and their representatives. People were asked for their consent for care and support, and they had their own tailored care plans in place. People’s needs around their nutrition, hydration, health and social support were recognised, discussed and addressed appropriately. The managers were highly involved in people’s care and ensured if people’s needs changed, support was offered to access other health and social care services timely.

The management team had good oversight of the safety and quality of people’s care, supported staff and promoted a positive, friendly culture in the service. The managers completed a range of audits and checks and made improvements to their governance systems and processes, as well as care planning and record keeping since the last inspection. The agency worked well with health and social care partners and within the local community.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 23 September 2020). We had previously carried out an announced fully comprehensive inspection of this service on 11 and 12 June 2019. At the inspection in 2020 we only reviewed two key questions, safe and well led to establish that the provider had met the breaches of regulations found during our previous inspection. The provider had met the previous breaches of regulations and these key questions were rated good at the time. However, the overall rating for this service had remained requires improvement. We carried out this inspection to review all the key questions and ratings.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Phoenix Care Services is a domiciliary care agency which provides personal care to people living in their own home. At the time of our inspection, the agency was providing the regulated activity of personal care to 17 people. People receiving the care were either living with dementia or elderly and frail.

People’s experience of using this service and what we found

Since our last inspection we found improvements had been made to the agency. This meant people received safe care as risks to people had been reviewed, medicines management systems had been updated and staff knew how to report safeguarding concerns. Other improvements included the introduction of an auditing programme and spot checks and supervisions carried out with staff. In general, the management of the agency had improved and there was a robustness about the management oversight.

People told us they felt safe with staff and that staff knew them well. Since our last inspection, risk assessments had been reviewed and updated. Detailed guidance was made available to staff and where staff were new to people, key information was provided about the person’s needs.

People said their medicines were given to them when they needed them and staff knew what they were doing. The introduction of an electronic medicines system had improved the management of medicines, this included the auditing of them.

People were protected from potential abuse as staff were now aware of what would constitute a safeguarding concern. They reported any concerns to the registered manager and the local authority and worked with them to investigate them. The registered manager had reviewed the requirements of registration in relation to notifications and understood the need to make us aware if there was a reportable incident.

People said staff had a good understanding of infection control and wore appropriate equipment when providing care to them. Staff were given sufficient PPE by the registered manager to enable them to carry out care in a safe way.

People received care from a consistent staff team who arrived on time and stayed for the amount of time expected of them. The agency employed a sufficient number of staff for the care packages they had and there was good communication between them and people who received care.

Feedback from people was sought on how the agency could improve and people told us they felt the agency was well managed and they felt comfortable raising concerns. The registered manager recognised the shortfalls identified at our last inspection and had worked to improve the service they provided and meet the requirements of registration. They continued to look at ways to improve and worked with external agencies to seek guidance and support to enable them to provide the most appropriate care to people.

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

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (report published 10 August 2019).

At this inspection we found improvements had been made and the provider was no longer in breach of regulations. They had also met the warning notices we issued them with at our last inspection.

Why we inspected

We carried out an announced fully comprehensive inspection of this service on 11 June 2019. Breaches of legal requirements were found and we took enforcement action against the provider. The provider completed an action plan after that to show what they would do and by when to improve the safety and management of the agency.

CQC have introduced focused inspections to follow up on Warning Notices and breaches of Regulation. A focused inspection does not include all key questions. We undertook this focused inspection to check whether the Warning Notices we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

At this inspection we reviewed the key questions of Safe and Well-Led. This report only covers our findings in relation to these key questions.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained as Requires Improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Phoenix Care Services on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme when we will carry out a fully comprehensive inspection looking at all key questions. If we receive any concerning information we may inspect sooner.

Phoenix Care Services Ltd is situated in Lingfield, Surrey. It is the only service owned by the provider. It is a domiciliary care service providing support to people living in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection, 24 people used the service, 23 of whom received the regulated activity of personal care. The service supported people with a range of needs, some were living with either a learning or a physical disability, others required support due to their older age and frailty.

People’s experience of using this service and what we found

People told us they felt safe, yet they were not always protected from the risk of harm. Medicines were not managed safely, and some people had gone without their prescribed medicines. Risks to people’s safety had not always been considered or lessened. Systems and processes did not always ensure that people were protected from the risk of abuse.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People’s privacy, dignity and confidentiality were not always maintained. Staff were not always responsive when there were changes in people’s needs. Staff had undertaking learning and development, yet findings found as part of the inspection raised concerns about their knowledge and understanding.

The service was not always well-led. Systems and processes did not enable the registered manager to have enough oversight to ensure people were receiving appropriate care. They had not notified us of incidents to enable us to have oversight and ensure that appropriate actions had been taken.

People told us staff were kind and compassionate. One person told us, “Carers are very nice. I get along with all of them.” People had access to healthcare and told us staff would contact the GP if they were unwell. People were happy with the service they received. One person told us, “Overall it’s very good, I’m impressed.”

Rating at last inspection

At the last inspection the service was rated as Good. (Published 22 December 2016). At this inspection, the overall rating for the service had changed to Requires Improvement.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well-led sections of this full report.

Enforcement

We have identified breaches in relation to people’s safety, their risk of abuse and improper treatment and the leadership and management of the service. The registered manager had failed to notify us of incidents that had occurred at the service. You can see what action we have asked the provider to take at the end of this full report. 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 continue to monitor the intelligence we receive about this service. We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We plan to inspect in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

People who receive a service include those living physical frailty or memory loss due to the progression of age. The agency also provides services to people living with dementia and people with mental health needs.

The service had a registered manager, who was present on the day of the inspection visit. 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 were protected from avoidable harm. We saw that staff received training in safeguarding adults and were able to demonstrate that they knew the procedures to follow should they have any concerns.

There were sufficient staff to keep people safe and to ensure that visits were completed within the agreed times. There was robust recruitment procedures in place to ensure that staff were safe to work with vulnerable people.

Staff had written guidance about risks to people health and safety and how to manage these. Risk assessments were in place for a variety of tasks like personal care, activities and the environment and were updated frequently.

People's human rights were protected as the registered manager ensured that the requirements of the Mental Capacity Act 2005 was followed. Staff assumed people had capacity to make decisions regarding their care, unless documentation was available to provide information that they do not.

People were happy with the support they received for example personal care and meal preparation. Changes in people's health care needs and their support was reviewed when required. If people required input from other healthcare professionals, this was arranged for them by staff.

People were supported by staff to maintain and improve their health and well-being. Staff supported people to have regular access to health and social care professionals.

Staff were trained and had sufficient skills and knowledge to support people effectively. There was a training programme in place and training to meet people's needs. Staff received regular supervision.

Positive and caring relationships had been established between people who received care, their families and the staff. We were told by people and their families that the staff interacted with people in a kind and caring manner.

People, their families, staff and other professionals were involved in planning people's care. We saw that people's choices and views were respected by staff. People's privacy and dignity was respected.

People received a personalised responsive service. Staff ensured that they supported people in ways that was their preferences and wishes and they were adhered to. People were supported by staff to maintain or to develop their daily living skills to promote their independence.

The care plans were person centred and contained clear, detailed information telling staff what support people wanted and how they wanted it.

The service was well led. The service listened to people, their families, staff and Social and Health professional’s views. The management welcomed feedback from people and acted upon this if necessary. The registered manager actively sought, encouraged and supported people's involvement in the improvement of the service by asking them to provide feedback formally by completing an annual quality check or informally during visits or telephone conversations. There were robust procedures in place to monitor, evaluate and improve the quality of care the service provided. The registered manager was passionate at introducing ways to improve the service.

The registered manager had ensured that accurate records relating to the care and treatment of people and the overall management of the service were maintained.

The registered manager promoted an open and person centred culture within the service.

Staff were motivated, dedicated and aware of their responsibilities in supporting, protecting and caring for people. Records for checks on health and safety, and medicines audits were all up to date. Accident and incident records were kept, and were analysed and used to improve the care provided to people.

The registered manager understood the requirements of CQC and sent appropriate notifications.

We saw that people's consent was obtained where possible before care and treatment was undertaken. We observed that the care given was safe and appropriate and based on effective care planning and risk assessments. This meant that people's individual needs were met and preferences were taken into account.

People were protected from abuse and cared for in a safe and inclusive environment. We also noted that people were cared for, or supported by, suitably qualified, skilled and experienced staff. In addition, the provider had an effective system to regularly assess and monitor the quality of service that people received.