Archived: Phoenix Residential Care Home

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.

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. 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.

Individual risks were not always assessed and managed to keep people safe. People could not be sure their prescribed medicines were always managed in a safe way. When people had accidents and incidents, action had been taken however, care plans and risk assessments had not always been reviewed and amended. Fire safety had improved, however their remained outstanding fire safety works.

The premises were not clean in all areas and plans had not been put in place to make sure people were living in a service that was kept clean and free from odours. We were not assured that the provider’s infection prevention and control policy was up to date. People were not supported to have a homely and individual bedroom to create a pleasant and personal environment.

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.

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 provider was in the process of carrying out a review of staffing against peoples assessed needs. Since the last inspection, the cleaner had left. Some cleaning had been carried out by care staff. This meant that staff were taken away from care and support and activities to complete these tasks.

Although two people's 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. People were still not provided with opportunities to follow their interests or offered meaningful occupation to prevent social isolation and maintain their well-being.

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 consultant to help them improve the service. The consultant had been involved since 26 September 2020. Some improvements had been made since the last inspection, many improvements were still needed. Improvements that had been made needed to be embedded and then sustained. This was the ninth inspection where the provider had not achieved a rating of good and the fifth consecutive rating of inadequate.

People received healthcare from professionals when they needed it. 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.

Staff wore appropriate personal protective equipment such as masks, gloves and aprons to keep themselves and people safe.

Staff knew people well. We observed caring, friendly interactions between staff and people. Staff recognised when people needed support or reassurance and provided this.

People were protected from the risk of abuse. Staff knew where they could go outside of the organisation to raise concerns if necessary.

Staff recruitment was now managed safely. Staff had received training to meet people's needs. Staff told us they felt able to ask for support and further training. Staff continued to receive regular individual support meetings and the provider held staff meetings to keep staff up to date.

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 in September 2020. The provider had not yet had the opportunity to analyse the results and provide a response but knew that people had said were bored, and they had started to increase opportunities for activities.

People told the provider in their surveys; ‘Quite happy with them, they do a good job’; ‘I like the staff’; ‘Nice staff’; ‘Well supported here’; ‘Everything fine’ and ‘Have a laugh with them [staff].’

Relatives commented in surveys; ‘I have always found everyone at Phoenix to be friendly and kind, the staff have made me feel reassured about my mother’s safety and wellbeing’; ‘She seems happy and content more so than when she lived in her own home’; ‘They [staff] are wonderful and caring, I know my mum is in great hands, I can approach them about anything’ and ‘Can always talk to management if I have any issues and always kept up to date with processes.’

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 16 September 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made 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 9, 11, 12, 15, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have also identified a new breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

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.

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. The service provides care and treatment 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.

There continued to be serious shortfalls in the service provided to people.

Individual risks were not always assessed and managed to keep people safe. People could not be sure their prescribed medicines were always managed in a safe way. When people had accidents and incidents, action had been taken however care plans and risk assessments had not always been reviewed and amended. Adequate plans were not in place to keep people safe from fire risks.

The premises were not clean in all areas and plans had not been put in place to make sure people were living in a service that was kept clean and free from odours. People were not supported to have a homely and individual bedroom to create a pleasant and personal environment.

People could not be assured new staff were adequately checked to ensure they were suitable to work with people to keep them safe.

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.

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.

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.

Although staff training had improved, there were still areas for concern where people may not have skilled staff on duty to provide their care. The provider had not updated all of their own training.

Infection control practice in relation to the latest COVID-19 government guidance for the use of PPE in care homes was not always followed to keep people and staff safe.

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. Only a few improvements had been made since the last inspection and this was a cause for concern. This was the eighth inspection where the provider had not achieved a rating of good and the fourth consecutive rating of inadequate.

Staff continued to receive regular individual support meetings and the provider held staff meetings to keep staff up to date.

Improvements had been made to food and fluid monitoring. People received healthcare from professionals when they needed it. Records in relation to healthcare advice and contact were not always complete.

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.

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 01 May 2020) and there were multiple breaches of regulation. The provider produced an action plan in May 2020.

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

Why we inspected

We undertook this focused inspection to gain an updated view of the care and support people received. This was a planned inspection based on the previous rating. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led.

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 the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe, effective and well led sections of this full report.

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 breaches in relation to regulations 11, 12, 15, 17, 18 and 19 at this inspection.

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.

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. The service can support up to 18 people in one adapted building.

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

Very few improvements had been made since the last inspection. The service provided to people continued to not be good.

Plans were not in place to keep people safe from fire risks. Individual risks were not always assessed and managed to keep people safe. People could not be assured the numbers of staff on shift were sufficient to provide the individual care needed to support their safety, health and well-being.

The premises were not clean in all areas and plans had not been put in place to make sure people were living in a service that was kept clean and free from odours. People were not supported to have a homely and individual bedroom to create a pleasant and personal environment.

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.

Staff had received training to meet people’s needs. There were concerns about the effectiveness of the training given.

Although people’s care plans had improved, providing more detail and personal information, there continued to be areas that needed to improve to make sure people received care and support in the way they wanted and needed. People were still not provided with the motivation and opportunity to follow their interests or offered meaningful occupation to prevent social isolation and maintain their well-being.

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. The provider had not updated their own training. Only few improvements had been made since the last inspection and this was a cause for concern. This was the seventh inspection where the provider had not achieved a rating of good and the third consecutive rating of inadequate.

Staff continued to receive regular individual support meetings and the provider held regular staff meetings to keep staff up to date. Staff recruitment continued to be managed safely.

People and their relatives had not made any complaints since the last inspection. At the last inspection, the provider had not appropriately dealt with complaints received. People were still supported well at the end of their life, although their wishes were not recorded well. This is an area for improvement. People’s medicines were now managed safely.

Staff knew people well and spoke about them in a caring and compassionate way. We saw caring interactions between staff and 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 inadequate (published 4 September 2019). At this inspection enough improvement had not been sustained and the provider was still in breach of regulations.

This service has been in Special Measures since 13 March 2019. During this inspection the provider demonstrated that enough improvements have not been made. The service continues to be rated as inadequate overall. Therefore, this service continues to be in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified six continued breaches in relation to safe care, staff deployment, suitability of the premises, consent and decision making, person centred care and quality monitoring, management and leadership, at this inspection.

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.

Since the last inspection we recognised that the provider had failed to display their ratings on their website. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

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.

Phoenix Residential Care Home is a residential care home accommodating up to 18 older people in one adapted building over two floors. There were 16 people living at the service at the time of our inspection. People had varying care needs, including, living with dementia, recovering from a stroke and diabetes. Some people could walk around independently, and other people needed the assistance of staff or staff and equipment to help them to move around.

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

Very few improvements had been made since the last inspection. The service provided to people who used the service was not good.

People were not protected from harm by robust safety measures to reduce risks. There were concerns around, people’s individual care; risks around the premises such as fire safety measures, unlocked doors to hazardous areas and laundry management; how people received their prescribed medicines and the monitoring of accident and incidents to learn lessons and prevent reoccurrence.

The numbers of staff on shift did not ensure people received the individual care needed to support their health and well-being. Recruitment of new staff followed safe practice.

Staff did not always receive training to keep their skills up to date. New staff did not complete essential training in a timely manner to make sure they had the knowledge to provide good support and keep people safe. Staff had one to one meetings with a manager and said they felt supported to do their job.

The evidence was not available to show how some people who were at risk of malnutrition were fully supported with their food and fluid needs. People were supported to access healthcare when they needed it. However, the advice given was not always used to update their care plans and therefore the advice was not always followed.

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.

The premises needed updating and although this had started in some areas of the service, it was slow and incomplete. Some people’s bedroom carpets needed replacing as they were worn and torn.

People’s care plans had improved in part but did not always provide up to date information as they had not been reviewed and people’s needs had changed. People’s daily records showed people did not receive the care they needed, for instance, some people were left in bed late which meant they missed essential care. People were not provided with the motivation or opportunity to follow their interests or offered meaningful occupation to prevent social isolation and maintain their well-being.

Staff knew people well and spoke about them in a caring way. We saw some caring interactions. People were supported to share their end of life wishes and these were documented. One relative told us their loved one had received good care at the end of their life.

People and their relatives were not encouraged to share their concerns and complaints in the knowledge they would be listened to. The provider did not take the opportunity to learn from complaints to make improvements.

The management and oversight of the service was not robust enough to identify areas of concern and put actions in place to continuously improve quality and safety. Improvements had not been made since the last inspection or previous inspections. This was the sixth inspection where the provider had not achieved a rating of good.

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 (inspected 27 November 2018 and published on 13 March 2019) and there were multiple breaches of regulation. We took enforcement action against the provider. We served two warning notices telling the provider they must make improvements to the quality and safety of care. We told them they must become compliant with Regulation 12 by 11 March 2019 and with Regulation 17 by 25 March 2019. The provider submitted a plan of action to show what they would do, and by when, to improve. At this inspection we found the provider had failed to make enough improvements and they were still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified six breaches at this inspection in relation to, risks to peoples safety and the safe management of their medicines; staff training and the numbers of staff on shift; people’s rights and how they consent to their care; the support to maintain peoples nutritional needs; how complaints and concerns were dealt with; accurate record keeping and the lack of oversight of the quality of care by the provider.

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.

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 the personal information that would help staff to support people in the way they wished at the end of their life.

Complaints had not been fully recorded and responded to and had not been used to improve service provision.

Staff had a good understanding of their responsibilities in relation to safeguarding people. However, safeguarding concerns raised by health and social care professionals were not always recorded to make sure changes in care were made and lessons were learned.

Meaningful activities that directly reflected people’s interests were not in place to make sure people’s social and emotional needs were responded to. This is an area that needed further improvement.

Written communication to give people the information they needed was not available in accessible formats to make sure people could understand and make decisions. This is an area identified as needing to improve.

Enough staff were employed and available to meet people’s needs. Safe recruitment processes were followed to make sure only suitable staff were employed. Staff were provided with regular one to one supervision to monitor their performance and staff meetings to provide support and information.

Fire alarm testing and fire evacuation drills were carried out to keep people safe. All essential maintenance and servicing had been carried out at the appropriate times. The provider was in the process of redecoration to improve the environment which had been put on hold during the winter months

Accidents and incidents were recorded and monitored by the registered manager to make sure safe practice was followed.

The registered manager carried out an assessment of people’s needs before they moved into the service to make sure the staff team could meet their needs.

People were complimentary about the food and had choices at mealtimes. They thought the staff were caring and friendly and told us their privacy was respected.

People, their visiting relatives and staff thought the registered manager was approachable and listened to their ideas and concerns. Regular meetings gave people the opportunity to give their views and contribute to the running of the service. Relatives meetings had been stopped due to a lack of attendance and a newsletter was being introduced instead, but some relatives thought meetings should continue to be on offer.

The registered manager had displayed the ratings from the last inspection, in October 2017, in a prominent place so that people and their visitors were able to see them.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

During this inspection we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the back of the full version of this report.

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

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 specific risk assessments were not in place to ensure their safety with people. Not all people were happy with the dog’s presence. We have made a recommendation about this.

Effective recruitment procedures were in place to check that potential staff employed were of good character. Appropriate numbers of staff were on the rota to meet people’s needs. However, people told us staff were not deployed suitably throughout the day to ensure staff were available to meet people’s needs. We have made a recommendation about this.

Staff had received the basic training required to carry out their role. Some specific training to meet people’s specialist needs had not been provided. We have made a recommendation about this.

Staff knew and understood how to protect people from abuse and harm and keep them safe. There was a good understanding within the staff team of people’s rights to make their own choices and decisions.

Maintenance of the premises had been routinely undertaken and records had been kept. Fire safety tests had been carried out and fire equipment safety-checked.

People did get choices of food at mealtimes. People were not always happy with the meals provided and said there had been a period of time without a cook which had an impact on quality. We have made a recommendation about this.

Some people felt some staff did not always have a kind and caring approach. The temperature in the service was not constant and people were complaining of feeling cold.

Staff supported people to maintain their independence and some people helped out with small tasks when they wanted to.

Complaints made in writing were recorded and investigated appropriately. Verbal and informal complaints had not been recorded or outcomes documented to learn lessons to make improvements. We have made a recommendation about this.

During this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we told the provider to take at the back of the full version of this report.

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 always received sufficient training to meet people’s needs. Courses that the provider considered mandatory were overdue the updates. New staff received an induction before starting to work at the service. Staff felt supported by the registered manager and said they were encouraged to discuss ideas and suggestions they had to improve the service.

People’s capacity to consent had not always been assessed as per the Mental Capacity Act 2005. Decisions had been made for people without their consent. Staff offered people choices and gained their consent prior to offering any support. Staff were kind and caring towards people however, people’s privacy and dignity were not always consistently maintained. We have made a recommendation about this.

People were given food and drink that they enjoyed and had chosen. People were supported to maintain their nutrition and hydration. Healthcare professionals were involved if people were at risk of malnutrition or dehydration.

People’s needs had been assessed to identify the care they required. Care and support was planned with people and their loved ones and reviewed to make sure people continued to have the support they needed. People were encouraged to be as independent as possible. Detailed guidance was provided to staff about how to meet people’s needs including any specialist support needs.

People were encouraged to participate in activities within the service and occasionally out in the community. People were involved and asked for suggestions of ways the service could be improved, these were acted on. People and their relatives had access to a compliant policy and procedure. Systems were in place to monitor the quality of the service being provided to people.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

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 staff on duty to meet people’s needs. Staffing levels had increased since the last inspection. A domestic member of staff had been employed to carry out cleaning and laundry tasks to enable the support staff to provide care and treatment to people .

Staff had been trained to understand their roles and responsibilities in relation to offering people choices about all aspects of their lives.

Care plans contained the information staff needed to support people effectively. People had been involved in the development of their care plans which linked to a risk assessment if this was required.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report. The breaches of Regulations found within this report will be checked at our next inspection. This service remains in special measures.