Care Home: Phoenix House

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What the care home does well Phoenix House has a friendly, family atmosphere and most residents have lived there for years. They say they are happy at the home and like the managers and staff. One relative says in a survey “We are happy X is well looked after”. Residents have good support with their personal care. Staff also ensure they have regular health care checks and manage their medicines safely for them. Phoenix House offers residents a comfortable and safe place to live. The home is near to shops and pubs etc. and is on a main bus route into Worcester city. This makes it easier for residents to mix in and be part of the local community. There is a small and stable staff team who work closely together. Residents staff, and their families and friends therefore all know each other very well. Staff receive training about how to keep the home and people safe. They have been checked out to help ensure they are suitable to work caring for people.Phoenix HouseDS0000018670.V378124.R01.S.docVersion 5.3 What has improved since the last inspection? Progress has been made to set up residents’ plans they understand and so can be more involved in. Plans also include some of their preferences and goals. Each resident now has a health action plan showing their health needs and how they are being monitored and met. The home has arranged for all residents to have an annual health care check. They have had a lot of support from a community nurse with these checks. What the care home could do better: Overall few changes have been made to improve the service since the last key inspection. Therefore most of the previous recommendations are made again. Residents would benefit from having more individualised support from staff to enable them to follow their personal interests and to achieve their goals. Residents could be better enabled to develop their skills and to make decisions about their own lives to help them move towards a more independent lifestyle. The building needs upgrading to make it nicer and have better furnishings and fittings. Residents would have more privacy and space if the owner carries out their plan to make another sitting room and give everyone their own bedroom. Staffing levels need to be increased so that residents can benefit from more individual and flexible support. The service should be reviewed and plans made to keep improving the home and to develop the service in ways residents want and/or for their benefit. Key inspection report CARE HOME ADULTS 18-65 Phoenix House 122 Bromyard Road St Johns Worcester Worcestershire WR2 5DJ Lead Inspector Christina Lavelle Key Unannounced Inspection 14th October 2009 02.30p Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Phoenix House Address 122 Bromyard Road St Johns Worcester Worcestershire WR2 5DJ 01905 426190 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Phoenixhouse122abtconnect.com Mr Nigel Hooper Mrs Susan Mary Jones Mr Nigel Hooper Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 11 2. The maximum number of service users who can be accommodated is: 11 25th September 2008 Date of last key inspection Brief Description of the Service: Phoenix House was first set up as a care home in 1986. Mr Nigel Hooper is the sole registered provider and joint manager with Mrs Susan Jones. Mr Hooper also runs another care home that is situated next door called Cedar Gardens. This home can provide accommodation with personal care for eleven adults. People living there must require care due because of learning disabilities. The property is a large, late Georgian, detached house situated on a main road on the west side of Worcester. There are shops, churches, pubs, and other facilities locally and the home is also on a main bus route into Worcester city. The house has garden areas at the front, side and rear. The home offers five single bedrooms and three shared bedrooms (none with en-suite facilities), of which two are on the ground floor. There is a sitting room, separate dining room, three bathrooms, two showers and three toilets for everyone to use. Information about the home is provided in a statement of purpose and service users’ guide. The guide is in a format that is easier for people with learning disabilities to understand and can be obtained from the home. The weekly fee for the service is as agreed with individuals’ funding authorities. Extra costs include for such as personal items and clothing, newspapers, telephone calls, hairdressing, chiropody, social activities, holidays, transport and college fees. Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people using the service experience adequate quality outcomes. This is a key inspection of the service provided by Phoenix House. This means all the Standards that can be most important to people using care services are assessed. Staff and people who are living at the home call people who use this service residents and so we, the commission, call them residents in our report. A range of evidence is used to make judgements about the quality of the service. We visited the home without telling staff or residents beforehand. We spent time during our visit with residents in their sitting room, also speaking to some individually about the home, their support and lifestyle. We had sent out surveys asking peoples’ views of the service. These surveys were returned by three residents, two of their relatives and four staff. We discussed how the service is run; changes made since the last inspection and plans to improve the service with the managers. Feedback received is referred to in this report. We checked some of the records that care services must keep about residents, staff and the home and looked around parts of the building. An annual quality assurance assessment (AQAA) self assessment form had been completed by the home, as required. The AQAA asks care managers to say what they think their service does well and could do better; what has improved in the last 12 months and about their plans for future improvements. Any other information we have received about the home since the last inspection is also considered. What the service does well: Phoenix House has a friendly, family atmosphere and most residents have lived there for years. They say they are happy at the home and like the managers and staff. One relative says in a survey “We are happy X is well looked after”. Residents have good support with their personal care. Staff also ensure they have regular health care checks and manage their medicines safely for them. Phoenix House offers residents a comfortable and safe place to live. The home is near to shops and pubs etc. and is on a main bus route into Worcester city. This makes it easier for residents to mix in and be part of the local community. There is a small and stable staff team who work closely together. Residents staff, and their families and friends therefore all know each other very well. Staff receive training about how to keep the home and people safe. They have been checked out to help ensure they are suitable to work caring for people. Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 6 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Prospective residents could be confident the home would be able to support them. This is because an assessment will be made of their care needs and the home would know their needs and wishes from involving them and people who are close to them in their needs assessment and admission. EVIDENCE: There has not been a new resident at Phoenix House for over four years. The home’s management has previously confirmed the assessment and admission procedures that the home would follow if a referral for a placement is made. They would expect to receive a copy of prospective residents’ community care assessments carried out by a care manager from their funding authority. The home’s manager would also visit people at their current residence to carry out their own needs assessment. They would then arrange introductory visits to the home and a trial stay. A review meeting would be held following their trial stays when a decision would be made about the suitability of their placement. Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 9 Mrs Jones reaffirmed that any prospective residents and their families and/or representatives would be fully involved in these assessment, admission and review processes. Staff and current residents would also be consulted during introductory visits and trial stays to check that new people are compatible. Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Each resident has a plan showing their care needs and the support they need to meet them. Whilst their plans include some personal goals they could be better enabled to achieve them; make decisions about their lives and take risks so that some of them could move towards a more independent lifestyle. EVIDENCE: Progress has been made since the last key inspection to set up more ‘person centred’ care plans for residents. This means they should have been involved in drawing up their own plans, which focus more on identifying their personal interests and goals and how they could be enabled to follow their interests and achieve their goals. Action planning meetings have been arranged to set up residents’ plans involving them, the manager, their keyworker from the staff team and other people they wish to invite such as a relative or friend. Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 11 The new plans are in an appropriate format that uses simple language. Some residents also have a life book including pictures and photographs of important people in their lives, their weekday activities, outings and holidays. We looked at a sample of residents’ care records. Plans are based on a needs assessment made in January 2008 showing the support they need with their personal care and a daily living skills assessment. Mrs Jones told us all plans are reviewed annually and their needs assessments indicate no changes. Plans now include peoples’ likes, dislikes, hopes and dreams, which were discussed in their planning meetings. Some specific personal goals are identified, which for one person are to have a special birthday party, go on the home’s group holiday and be more sociable with a certain friend. However there was no detail about the type of party they want, who to invite, who would help them organise it etc or how they are being enabled to see their friend more. This should all be part of an action plan and then the actions taken and progress to achieve their goals should be reviewed regularly with outcomes recorded. Whilst plans are more person centred the home still needs to fully implement a more person centred approach to care delivery that would enable residents to achieve their identified goals. keyworkers from the staff team are allocated to each resident but they are currently not able to give any individualised support because their time is so limited due to staffing levels. If keyworkers could provide some one to one input they should get to know residents’ needs and wishes better and could be more actively involved in helping them plan and review their care plans to ensure that their needs and goals are being met. Plans include general risk assessments about such as bathing, medicines, using the kitchen, transport and going out. Specific risk assessments should also be carried out for individuals and that could promote a more independent lifestyle. One person’s plan says they can get angry, frustrated and jealous of the other residents but does not describe how and the impact on them and other people. A management plan should also be in place for staff to follow to ensure that they all know how and deal with these behaviours consistently and effectively. Another plan shows that the person has no verbal communication. Mrs Jones told us a communication profile was once drawn up by a speech therapist but they choose not to use signs etc. This should be reviewed as ensuring that people can communicate their needs and wishes is essential. More able residents confirm they can make decisions about what they do every day but residents who rely on staff support have fewer opportunities. Some residents could also take more control of their lives. The AQAA states that residents’ meetings are held “when they can voice their opinions on issues that are important to them and the home” but the last one held was in March. Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 and 17 People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Residents take part in various activities; some in their local community. They would benefit from more individualised support to meet their personal interests and goals. Their independence could be better promoted if they are enabled to take more responsibility in their daily lives. Residents are supported to keep in touch with their family and friends and staff also aim to provide a healthy diet. EVIDENCE: Phoenix House is well established within the local community. The home has its own vehicles but residents also have bus passes and a few regularly use public transport. Residents’ activities still comprise mostly of their weekday day services, college and/or work placements. Unless they can go out without staff their social activities are with other residents as a group, such as to a Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 13 social club for people with learning disabilities, occasional meals out, outings and holidays. They also have a weekly night out at a nearby public house. The AQAA states that the home has a group holiday because residents prefer this to individual holidays and they are asked where they would like to go. The AQAA says the home has met requests and introduced residents to more activities. The only example given is one person now using sensory facilities in the community. Staff say this activity is appropriate for their needs and they enjoy going but their plan says they can only go when there are three staff on duty. This is two weekly and not as frequent as would best suit and benefit the person. The managers say that staffing levels and lack of support available to residents is due to funding and so should be considered in placement reviews. The home recognises the need to support residents to develop independent living skills. Currently they are expected to keep their own rooms tidy and can choose to be involved in the home’s domestic routines. Their independence is not really facilitated however, as for example one person attends cookery classes but told us they only make a very occasional snack meal at home. Residents should be encouraged to take more responsibility for the day-to-day running of the home such as menu planning, meal preparation and cooking. It is clear the home maintains a group approach to residents’ lifestyle and activities. Residents from Cedar Gardens also still go to Phoenix House during the day when they have no weekday activities so that staff can support both resident groups. Whilst there is a friendly, family atmosphere, and this is what residents know and are used to, current good practice for supporting people with learning disabilities is to promote peoples’ independence. Efforts should therefore continue to do this and to provide a more individualised service. Residents are supported by the home to keep in contact with their relatives through telephone calls and visits and some people go out and stay with their family regularly. Their friends and visitors are made welcome in the home and are well known to the managers and staff. Social events for such as birthdays and Christmas are arranged when their families and friends are also invited. Regarding food provided by the home the main meals are chosen each day by staff and recorded. We saw in the records that this includes mostly traditional meals such as roasts and fish on Friday. Residents have the same main meal and staff know what people like. The AQAA says that staff try to “advise and promote a healthy diet and residents can choose something else other than what is on the menu on any given day”. Residents say that their food is good but they are not actively involved in meal provision, as already discussed Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Each resident receives the support they need with their personal care. Staff monitor their health and ensure that their physical health needs are met. They also manage residents’ medicines safely in the home on their behalf. EVIDENCE: Residents’ plans outline the support individuals need with their personal care; although they could show how their self-care is being promoted better. A risk assessment is carried out when any supervision for such as bathing is needed. Progress has been made since the last inspection to set up individual health action plans for residents. This plan format has simple language with pictures and one copy is kept in the office and another in residents’ bedrooms. These plans cover all relevant health related areas and should give a comprehensive overview of residents’ individual health, needs and requirements. Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 15 Residents’ care records include a brief health history and health action plans record all health care input and routine appointments e.g. optician and dental check ups and GP visits. Physical checks such as weight are kept as well as input, reports and letters from health care specialists. One person has an epilepsy management plan and a diary of their seizures is also kept by staff. These records show staff monitor residents’ health and well-being and take action whenever necessary to respond to any changes or problems. Staff also ensure that routine and specialist health check ups are arranged and support residents to attend them. The home has recently made arrangements for all residents to have an annual well person check. Mrs Jones told us the home has had a lot of input from a community nurse to carry out these checks. Regarding medication prescribed for residents we previously confirmed that the home has an appropriate policy and procedures in place for safe management of medicines for staff to follow. Residents all have a medication profile, with their photograph, detailing their prescribed medicines and possible side effects. There is also a self-medication assessment form available and we saw that one resident had signed their consent to staff administering their medicines. The home provides suitably safe storage for medicines. All staff designated to administer have received formal training on the safe handling of medicines and there is a record of these staff signatures. We saw that records of medicines kept and administered in the home are maintained appropriately. Prescriptions are copied and medicines are checked into the home and audited. Community Pharmacists for Worcestershire NHS visit the home regularly to check their system and found it was satisfactory in their latest inspection in April 2009. Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Residents feel able to express their views and if people have any concerns they are confident that the managers and staff will listen and act on what they say. The home safeguards residents from abuse, neglect and self-harm. EVIDENCE: The home has a written complaints procedure that is also available in a userfriendly format. There is a copy on the notice board and some residents have one in their bedroom. There is also a record for managers to complete when complaints are made, which would detail their investigations, actions taken and outcomes. There have not been any complaints made to the home or to the commission about the service, or any referrals made under local multi-agency safeguarding procedures for vulnerable adults, since the last inspection. We saw there is a positive and open rapport between residents, managers and staff. Staff confirm in their surveys that they would know what to do if anyone raised concerns with them about the home. The AQAA states that “we have a good rapport between residents and staff. Their families are also aware of the procedures for any matter that arises and know they are able to communicate freely and express their concerns”. One resident’s relative indicates in their survey that any concerns they have raised had been dealt with appropriately. The home provides guidance and procedures for the protection of vulnerable adults and the staff team have received training on abuse and safeguarding. Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable, clean and safe home but they would benefit from a better maintained and upgraded environment with more private space. EVIDENCE: Phoenix House is in a busy area on the west side of Worcester city. There are shops, pubs, Churches etc. within walking distance and the home is on a main bus route into Worcester. The house is detached and in keeping with the local community. It was extended to provide accommodation for eleven people. The overall impression of the home’s environment is homely but the furniture, décor and furnishings need upgrading. The kitchen and bathrooms are tatty and dated and kitchen units need replacing, which was also recommended by an Environmental Health officer. The AQAA does not detail any improvements Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 18 made to the environment during the last 12 months and residents told us they would like their sitting room refurnished and redecorated. There should be a planned renewal programme for the premises, with records kept. The owner’s plan to extend the home to provide another sitting room and all single bedrooms, as discussed in previous inspections, has also not yet started. We know from the last inspection that at least one resident is not happy about having to share a bedroom and there is currently only one sitting room for 11 people. We are told they still intend to build this extension but are awaiting action by Worcestershire Council in respect of their funding for placements. We found that all areas of the house we visited were clean, tidy and fresh. In relation to hygiene and infection control we have previously confirmed that the home provides relevant policies and procedures for staff to follow and the AQAA states there are suitable arrangements in place for the disposal of soiled waste. Staff have gloves and protective clothing to use if necessary and most of the team have received training on infection control. Whilst liquid soap and alcohol gel are used in the bathrooms, consideration should also be given to providing paper instead of linen towels, as this promotes better hygiene. Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Residents receive safe and good personal support from suitably trained staff but would benefit from more staff input and individualised support. People can be confident in staff as checks are made to help to ensure they are suitable. EVIDENCE: There is a small, stable care staff team of seven who work in both the owner’s homes. This is positive in one way because staff and residents know each other well and so support is consistent. Rotas we saw show there are normally two staff on duty during the day time, one staff sleeping in over night and that the owner and manager are also included in the care shifts covering the home. As we have also found in previous inspections staff still have very limited time available to offer any individual input to residents to enable them to pursue activities they choose or to support them to develop their daily living skills. Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 20 Staff focus on giving personal care, cooking, household tasks, transporting residents to their weekday activities and escorting them at their evening group social activities. Staffing arrangements also still include the owner’s other home, which means that during weekdays residents from Cedar Gardens who are not engaged in regular activities spend the day at Phoenix House so they can be supervised by staff. The AQAA confirms our view that the home could do better if staff could “give residents more one to one and try to support them to achieve some of their chosen goals”. Staff also say in their surveys that the home could be better if there were more staff. The AQAA and staff surveys confirm all staff had criminal record bureau (CRB) checks and two references taken up before they started working at the home. One weekend care worker left the home recently but a new person has been appointed. We checked their records and found the home has proof of their identity and their full employment history, as required. A CRB had been taken up and two references requested, one from their last and only employer. Only this reference has been returned but the manager told us she is following the other up and will ask for another referee if necessary. Until this is obtained the new person will just be working alongside managers as part of their induction. Staff indicate in surveys that their induction covered everything they need to know and they receive training relevant to their role. Four staff have achieved an NVQ (National Vocational Qualification) in social care. Each staff member has a training record and just before the previous inspection most staff attended training sessions on abuse, epilepsy and autism. Whilst all staff have completed mandatory health and safety training, some topics need updating. The small staff team work well together although there are few formal support processes operating. The last staff meeting was held in March and managers are not carrying out individual formal supervision, which the standards specify care homes should at regular intervals to monitor work performance and identify individuals’ training and developmental needs, which is recorded. Staff comment in their surveys that “the home has a routine structure followed by all staff which makes it a good team and our jobs easier” and “I enjoy my job at Phoenix house. It is a pleasant home and service users are happy””. . Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Residents would benefit if the ethos and approach of the home is updated to reflect currently accepted good practice. An effective quality assurance system should result in plans to develop the service, based on what residents want and/or would benefit them. The home’s environment is kept safe for people because health and safety practices are carried out. EVIDENCE: We found during our visit that there is a caring, friendly atmosphere in the home. Residents seem to have accepted the style of the home being that of a family/group living environment and those asked say they like living there. Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 22 This approach however does not focus on and so promote residents moving towards a more independent lifestyle, as is currently accepted as good practice for people with learning disabilities and in line with the government’s plans. There have essentially been no changes made to the way that the home is managed or its ethos or approach since previous inspections. Although some progress has been made to set up person centred and health action plans there is not really more of a person centred approach to the way the service is run. The home recognises that this can only be achieved by a more individualised approach and opportunities for residents to make choices and decisions in their lives but the home still does not have the staff and/or time to facilitate and develop this. Lack of funding is cited as being the main reason and so this still needs to reviewed with residents’ funding authorities The AQAA is brief, providing limited evidence of how what the home does well results in good outcomes for residents. Some key aspects of the National Minimum Standards are also not referred to such as the home’s management of medication, recruitment, training and quality assurance. Few improvements or any plans for future improvements are also described, which should be part of an effective quality assurance system that uses feedback from residents and other stakeholders to plan continual improvements to the service. Regarding health and safety in the home, training is arranged for staff on the mandatory health and safety topics including fire safety, first aid, moving and handling, food hygiene and infection control. Staff have also completed training on abuse and safe management of medicines. The AQAA confirms that tests and checks on the home’s fire system and equipment are being carried out. Gas and central heating services are also maintained/serviced, checks made on portable appliances and COSHH risk assessments in place. We observed there were no safety hazards during our inspection visit and overall the home pays due attention to promoting the health safety and welfare of residents and staff. . Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 2 1 X X 3 X Version 5.3 Page 24 Phoenix House DS0000018670.V378124.R01.S.doc Are there any outstanding requirements from the last inspection? NA STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered persons meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered provider must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the registered provider to consider carrying out. N Refer to o. Standard 1. YA6 Good Practice Recommendations Progress should continue to fully implement a more person centred approach to care planning and delivery. This would help to ensure that residents are enabled to follow their individual interests and to achieve their personal goals. Residents should have more opportunity for individualised activities and their responsibilities in their daily lives should be promoted to help them develop their life skills. The home should draw up a planned renewal programme for the fabric and decoration of the premises so the environment is of good quality for residents. The proposed extension to the home should also be progressed so everyone can have the privacy of a single bedroom and more communal space. Staffing should be reviewed and consideration given to increasing staffing levels so that residents could benefit from more individualised and flexible support. 2. YA16 3. YA24 4. YA33 Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 25 5. YA37 The ethos and approach of the service still needs to be reviewed and updated so that the home is run in a way that reflects currently accepted practice for supporting people with learning disabilities. This should be based on the residents being enabled to make more decisions and move towards leading a more independent lifestyle. The home should have ways in place to continually monitor, review and develop the service. This should result in an action plan for the continual improvement of the service, as residents want and/or which will benefit them. 6. YA39 Phoenix House DS0000018670.V378124.R01.S.doc Version 5.3 Page 26 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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