Background to this inspection
Updated
10 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. 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.
Inspection team
This inspection was carried out by two inspectors.
Service and service type
Phoenix House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service did not have a manager registered with the Care Quality Commission. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided. There had been no registered manager in post since July 2019. The current manager had been in post since June 2020 and is currently applying to register.
Notice of inspection
This 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, professionals who work with the service and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. 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. We used all of this information to plan our inspection.
During the inspection
We spoke with seven people about their experience of the care provided. We spoke to six members of staff including the manager, deputy manager, care workers, agency staff and cook. We spoke to two consultants that the provider had employed. We made observations of care to help us understand the experiences of people who chose not to talk with us. We reviewed a range of records. This included four people's care records and medication records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service including accident and incident records and daily records were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. The manager sent us additional information after the inspection. This included staff training and supervision schedules, quality assurance and audit information, the statement of purpose, incident records and daily reports.
Updated
10 November 2020
About the service
Phoenix House provides accommodation and personal care for up to 24 people who need support with their mental health needs in one adapted building. There were 16 people living at the service at the time of the inspection. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
People’s experience of using this service and what we found
People had been harmed or were at risk of harm due to poor risk management. Safeguarding incidents were not always reported or investigated appropriately. Lessons were not learnt, and people continued to be at risk of harm from other people. People continued to receive medicines to control their behaviour in an inconsistent way, people’s health needs were not managed safely. There were not enough skilled or trained staff to support people.
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 were poorly trained and supervised. Due to their lack of knowledge or skills, management of incidents was poor and people had been unnecessarily restricted as a result. People were not empowered to take control over the lives, they were not supported to develop skills and reach their full potential. Working with other healthcare professionals did not always happen leaving people at risk from health needs such as diabetes or constipation.
The provider had failed to act to rectify shortfalls found at previous inspections. This is the seventh consecutive inspection where the service has been rated either requires improvement or inadequate. There has been no sustained improvement. The provider and their representatives have continually failed to provide sufficient oversight of the service and has not responded appropriately to the concerns we have raised.
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 and was placed in special measures (published 20 December 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. The service has been inspected seven times since November 2015 and has continued to be rated either Requires Improvement or Inadequate. At this inspection not enough improvement had been made or sustained and the provider was still in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 7 & 8 October 2019. Breaches of legal requirements were found in safeguarding service users from abuse and improper treatment, safe care and treatment, staffing, dignity and respect, person-centred care, good governance and notification of other incidents. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.
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 stayed the same. 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 House on our website at www.cqc.org.uk.
We have found evidence that the provider needs to make improvement. Please see the Safe, Effective and Well-led sections of this full report.
Enforcement
We have identified breaches in relation to Safe care and treatment, Safeguarding service users from abuse and improper treatment, Staffing, Person-centred care, Dignity and respect, Need for consent, Good governance and Notification of other incidents at this inspection. 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.
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 of 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.