Archived: Phoenix Residential Care Home

Updated 20 April 2021

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. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by three inspectors. Two inspectors visited the service and a third inspector collated and reviewed information we asked the provider to send us by email during the inspection.

Service and service type

Phoenix Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with CQC. The registered manager was also the provider. This means that they are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

The first day of the inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service, and the local Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. Healthwatch told us they had not visited the service or received any comments or concerns since the last inspection. A local authority commissioner told us they were continuing to carry out monitoring of the service. We used all of this information to plan our inspection.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with four people who used the service about their experience of the care provided. Some people were not able to verbally express their experiences of living at the service. We observed staff interactions with people and observed care and support in communal areas. We also spoke with three relatives. We spoke with 11 members of staff including the provider, the deputy manager, team leaders, support workers, housekeeper, cook and agency staff.

We reviewed a range of records. This included six people’s care records and a selection of people’s medicines records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data, audits and staff allocation records.

Updated 20 April 2021

About the service

Phoenix Residential Care Home is a residential care home providing personal care to 13 people aged 65 and over at the time of the inspection, one of the 13 people was in hospital. The service provides care and accommodation to younger adults, older adults and people living with dementia as well as other health conditions. The service can support up to 18 people.

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

Although some improvements had been made since we last inspected the service, there continued to be serious shortfalls in the service provided to people. Some improvements previously made had not been sustained.

Most staff knew people well. Whilst we observed caring, friendly interactions between staff and people, we also observed interactions which demonstrated that people were not treated with dignity and respect.

Individual risks were not always assessed and managed to keep people safe. Staff did not always follow the guidance in people’s risk assessments. When people had accidents and incidents, care plans and risk assessments had been reviewed and amended. However, action had not always been taken in a timely manner which put people at risk of harm. Some people were at risk of falls, and although risk assessments were in place, they had not been updated following subsequent falls.

Although people had an assessment of their care needs, this had not always been robust and had not been reviewed appropriately to ensure their safety and wellbeing.

People could not be assured there were enough staff on duty at night to make sure they could be evacuated safely if an emergency such as a fire took place. The level of staffing during the day had improved. The provider had employed a housekeeper, an activities staff member and care staff. People could not be assured new staff were adequately checked to ensure they were suitable to work with people to keep them safe. Although staff training had improved, there were still areas for concern where people may not have skilled staff on duty to provide their care.

Although care plans had improved, there continued to be areas that needed to improve to make sure people received care and support in the way they wanted and needed. Some people received inconsistent care and support with their continence needs.

The management and oversight of the service was still not robust enough to identify areas of concern and put actions in place to continuously improve quality and safety. Since the last inspection, the provider had employed a new consultant to help them improve the service. The consultant had been involved since mid-November 2020. Improvements that had been made needed to be embedded and then sustained. Some improvements found at our last inspection in November 2020 had not been sustained. This was the 10th inspection where the provider had not achieved a rating of good and the sixth consecutive rating of inadequate.

People were not always safeguarded from the risk of abuse. People had not always received healthcare from professionals when they needed it.

We were not fully assured that the provider's infection prevention and control policy was up to date. Staff wore appropriate personal protective equipment such as masks, gloves and aprons to keep themselves and people safe.

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

People did not always have choices of meals at each mealtime. Despite easy to read pictorial menus being available at the last inspection, the use of these had not been embedded into day to day practice. Staff did not use these to help people make a choice of food at each meal and the pictures were not left on display to help people remember what the menu options were.

Improvements had been made to accessible information within the service to help people to understand information, choices and be involved in their care and support. This was not yet embedded. We made a recommendation about this.

People attended meetings to discuss the service and other important information. Those who did not attend were given opportunities individually to be involved after the meeting.

Medicines management had improved. People’s prescribed medicines were managed in a safe way. There were some further improvements required in relation to as and when required medicines.

Fire safety had improved, however their remained outstanding fire safety works. The premises were cleaner and was free from odours. Some areas of the service had undergone redecoration. Some work had been done with people and their relatives to make bedrooms more personal.

People and their relatives had not made any complaints since the last inspection. People and some relatives had completed surveys of their care and experiences. The provider had started to take action to address the feedback gained. People now had more activities to prevent them from being bored. People now had some opportunities to follow their interests and were offered meaningful occupation to prevent social isolation and maintain their well-being. The provider had received a few compliments. These included one from a relative who had been sent pictures of their loved one enjoying their birthday. The relative said, ‘Bless you guys for looking after her so well and giving her the hugs that I can’t.’

Some changes to end of life care plans had been made since the last inspection. Some people and their families had been encouraged and supported to discuss their choices and preferences.

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 Inadequate (published 24 November 2020).

The provider completed an action plan after the last inspection and each week thereafter to show what they would do and by when to improve.

At this inspection enough improvement had not been made and sustained and the provider was still in breach of regulations.

Why we inspected

We undertook this inspection to gain an updated view of the care and support people received. This was a planned inspection based on the previous rating. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has remained inadequate. This is based on the findings at this inspection.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and new breaches in relation to regulations 9, 10, 13 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.