Phoenix Care Cornwall Limited

At the previous inspection in April 2106 the Safe section of the report was rated as Requires Improvement and a recommendation was made around medicine administration and records. Since the inspection the service has reviewed its medicines policy, care plans and risk assessments. The service had a robust process in place to ensure medicines were administered as directed and with people’s permission. At this inspection we found improvements had been made in the Safe section and the service had met the recommendation made following the April 2016 inspection. Therefore, the rating of the Safe section has changed from Requires Improvement to Good. The overall rating of the service remains Good.

Phoenix Care Cornwall is a Domiciliary Care Agency that provides care and support to adults, in their own homes. The service provides help and support with people’s personal care needs in Penzance and surrounding areas of Cornwall. The service mainly provides personal care for people in short visits at key times of the day to help people get up in the morning, go to bed at night and support with meals.

At the time of our inspection 57 people were receiving a personal care service. These services were funded either privately or through Cornwall Council or NHS funding. There were 30 staff employed, some of those were office based to coordinate and manage the service. There were two registered managers in place at the time of our inspection. 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 were extremely satisfied with the quality of the service they received and the caring approach from staff. People and family members told us they would recommend Phoenix Care based on their positive experiences. Comments from people included; “Everyone (care staff) is different but they are all very nice and good at their job. I have got no complaints whatsoever”, “The staff are fabulous"," I couldn’t ask for better staff; they are friendly, polite, professional, and nothing is too much trouble” and “They are lovely, it’s the highlight of my day when they come.”

People told us they had not experienced a missed care visit. The service had robust and effective procedures in place to ensure that all planned care visits were provided. The service's visit schedules were well organised and there were a sufficient number of staff available to provide people's care visits in accordance with their preferences.

People told us that their visits were on time but there were 'rare occasions' when care staff could be late for their planned visits. However, people did not have a concern regarding this as they understood that any lateness was due to care staff needing to provide extra support to a person in an emergency or due to travel issues, especially in holiday seasons. People told us that Phoenix Care office staff would phone them if a care worker was going to be late which gave them reassurance that their visit would still continue. Phoenix Care operated an on-call system outside of office hours. Care staff told us managers would respond promptly to any queries they might have.

People received care and support from a consistent team of staff with whom they were familiar. Staff arrived on time and stayed for the full time allocated. People spoke positively about the staff that supported them and told us they were always treated with care, respect and kindness. Staff were respectful of people’s privacy and maintained their dignity. Staff had developed good relationships with people and were familiar with their needs, routines and preferences

Staff were respectful of the fact they were working in people's homes. The service offered flexible support to people and were able to adapt in order to meet people's needs and support them as they wanted.

There were processes in place to protect people and the security of their home when they received personal care, including staff wearing uniforms and carrying identification. People received information about who they should expect to be delivering their care so they were aware of who was due to call upon them.

People told us they felt safe and that staff had the skills and knowledge to provide the required care. Safeguarding procedures were in place and staff understood their responsibilities to safeguard people from abuse. Potential risks to people's safety and wellbeing had been assessed and managed. Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided. Accidents and incidents were reported and reviewed to reduce the risk of an incident occurring again.

Staff were recruited in a safe way and there were enough to meet people's needs. Staff were supported by a system of induction, training, one-to-one supervision and appraisals to ensure they were effective in their role.

Staff knew how to ensure each person was supported as an individual in a way that did not discriminate against them in any way. People's legal rights were understood and upheld. Everyone told us staff ensured their dignity and privacy was promoted.

People told us staff had sought their consent for their care. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. Staff had received relevant training and understood the principles of the Act.

People's care plans were detailed, personalised and provided staff with sufficient information to enable them to meet people's care needs. The care plans included objectives for the planned care that had been agreed between the service and the individual. All of the care plans we reviewed were up to date and accurately reflected each person's individual needs and wishes. The service's risk assessment procedures were designed to enable people to take risks while providing appropriate protection.

The registered provider and management team provided clear leadership to the staff team and were valued by people, staff and relatives. There was a whole team culture, the focus of which was how they could do things better for people.

Feedback about individual care staff and the office staff was consistently positive with no adverse comments in any areas. People described the management of the service as open and approachable. People and their families were given information about how to complain. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.

Phoenix Care is a domiciliary care provider based in Cornwall providing personal care and support to people in their own homes. On the day of the inspection 65 people were receiving a service. Phoenix Care support people with varied health care needs including physical disabilities, sensory disabilities, mental health needs and dementia. Support packages ranged from fifteen minutes to prompt people to take medication to nine hour overnight support.

There was a registered manager in post. 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 and relatives told us they felt the care and support provided by Phoenix Care was safe. Comments included; “They’re all very nice, very good”, “I definitely feel safe” and “I’m very, very fortunate. They’re always polite and helpful.”

Staff had received training in safeguarding adults and children, and were aware of the service’s safeguarding and whistleblowing policies. Information on how to raise a concern was available on notice boards in the office and in the staff handbook. The organisation’s safeguarding policy contained the most up to date information for local reporting procedures.

There were a range of risk assessments in place to help ensure the safety of both people receiving a service and staff. These included assessments in respect of the environment and any equipment in people’s homes.

One person needed additional support to take their medicines. This had not been recorded appropriately in the persons care plan. Staff recorded when people took their medicine and there was comprehensive information about people’s medicines in the care plans.

There were sufficient numbers of suitably qualified staff available to ensure all packages of care were covered safely. Staff rotas were organised to try and provide people with a consistent service from a small number of carers. People told us they knew most of their carer’s well and that new members of staff always visited with more experienced staff on the first visit.

Staff received regular in house training. They told us they were able to approach the office staff or trainer with any questions they had. The registered manager, care co-ordinators and trainer all provided care and staff told us this meant they had an understanding of their job and; “Know what’s going on.” There was a robust system of induction, supervisions and appraisals in place.

The registered manager had a clear understanding of the Mental Capacity Act 2005 (MCA) and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. Staff spoke of the importance of ensuring people were supported to make decisions and their right to do this even if staff considered the decisions to be unwise.

Care plans were informative and gave staff clear guidance as to the care and support people needed. They were reviewed regularly and people were encouraged to be involved in the reviews. If people could not be involved due to their health needs, families were invited to contribute if appropriate. Any changes in people’s needs were communicated effectively to the staff team. There were safeguards in place to protect people’s confidentiality.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and allied professionals who had experience of the agency and from reviewing records.

Is the service safe? From the information gathered during our inspection we concluded the service was safe. People told us they felt safe. People told us that they felt their rights and dignity were respected. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective? We found the service was effective. People's health and care needs were assessed with them, and they were involved in writing and review of their plans of care. People said that their care plans were up-to-date and reflected their current needs.

Is the service caring? We found the service was caring. During our inspection we spoke with the office manager and Human Resources manager and two care staff who also worked in the office. In addition we spoke with two allied professionals with experience of the agency, nine people being supported by the service and an additional six care staff by telephone. We asked people for their opinions about the service and the staff that supported them. Feedback from people was positive, for example, 'the staff are lovely, very caring' and 'I think Phoenix provide a good quality service'. When speaking with staff it was clear they had a good opinion of the agency and genuinely cared for the people they supported.

Is the service responsive? We concluded that the service provided to people by Phoenix was responsive. People had regular reviews of their care plans and told us they could approach care staff and management with any issues. People told us they knew how to make a complaint if they were unhappy. The service worked well with other agencies and services to make sure people received care and support in a coherent way.

Is the service well-led? We concluded the service was well led. The service had a quality assurance system, and records showed problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service and quality assurance processes. This helped to ensure that people received a good quality service at all times.

The registered manager was aware of the needs of all the people who used the service. The care plans were up to date and included advice from professionals involved in a person's care.

The agency had suitable arrangements in place for obtaining, and acting in accordance with, the consent of service users in relation to the care and treatment provided for them.

People told us and we saw evidence of pre-care assessments including risk assessments of peoples' needs to ensure the agency could provide the required level of care. The care plans we reviewed were sufficiently detailed to direct and inform staff about how care was to be provided. We saw evidence of regular reviews of care plans to ensure the care provided took account of any changes that had occurred. The provider did not provide safe and co-ordinated care, treatment and support where more than one provider was involved, or people moved between services.

Staff were supported to deliver care and treatment safely and to an appropriate standard.

People were protected against the risk of inappropriate or unsafe care and treatment because the provider had effective systems in place which assessed and monitored the quality of services provided by the agency.

Records that we looked at evidenced that people were involved in choosing how and when they wanted their care and support. This indicated that people were involved in planning their care on a daily basis.

During the inspection we found that staff were provided with induction training and received refresher training every year. The manager provided staff with opportunities for additional learning and ensured that training was kept up to date. This meant that people's needs were met due to the experience and level of skill of all staff.

There was not any evidence that risks were being regularly monitored or that procedures were put in place to minimise risks occurring in the future. This meant that people who used the service did not always experience care that met their needs. Records we looked at showed that care plans were not always updated when people had accidents. This meant that they were unable to highlight any patterns or triggers and put procedures in place to minimise the risk of it happening again.