This inspection took place on 5 and 12 September 2018 and was unannounced.

Phoenix House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under on contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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 15 people living at the service at the time of the inspection.

The service had a registered manager. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

The service was placed in special measures following our inspection in July 2017, when the service was rated inadequate in all domains. We took enforcement action and placed a restriction on the provider’s registration so they could not admit any people to the service without prior written consent from CQC. We inspected the service on 06 March 2018 to check that the provider had complied with their action plan and confirm that they now met legal requirements. Improvements had been made but there were continued breaches and a new breach of regulations.

We found breaches of Regulations 9, 10, 12, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Risks to people had not been identified, assessed and mitigated. The provider had failed to ensure that care was provided in a safe way to people. The provider had failed to ensure that staff were safe to work with people. The provider failed to ensure that staff were suitably qualified, competent, skilled and experienced. People's independence and autonomy was not fully promoted. The provider had failed to consistently involve people and their relatives in planning their care and people did not always receive person-centred care. The service had not sufficiently improved or developed. The provider had failed to maintain accurate and complete records. The provider had failed to establish and operate systems to assess, monitor and improve the quality of the services provided and reduce risks to people. The registered manager had not been working full time at the service for some months, and the service had not sustained improvement and was rated Requires Improvement overall and Inadequate in well led.

The provider sent us regular updates and action plans with timescales stating they would be compliant with the regulations. We undertook this inspection to check they had followed their plan and to check that they now met legal requirements. Improvements had been made and the service now met legal requirements but some further improvements were needed for the service to be rated Good overall. This is therefore the fifth time the service has been rated Requires Improvement or Inadequate.

Previously, the registered persons had failed to monitor, support and have oversight of the service. The registered manager was now working full time at the service and the provider completed a monthly audit of the quality of the service. The registered manager had completed checks and audits, shortfalls had been identified and action had been taken. However, there was no action plans in place to identify what needed to be done, who was responsible and when it should be completed by. This was an area for improvement.

There had been a towel rail that was very hot and there was a risk of scalding, at this inspection, it had been covered. Regular audits had been completed on the building and any shortfalls had been rectified.

At this inspection, improvements had been made relating to the management of risk, there was now detailed guidance for staff to follow including about h

This inspection took place on 6 March 2018 and was unannounced

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.

Phoenix House provides accommodation and personal care for up to 24 people who need support with their mental health needs. There were 14 people living at the service at the time of the inspection. The service is situated in its own extensive grounds and gardens in the rural village of Northbourne, which is close to the seafront towns of Deal and Sandwich.

The care and support needs of the people varied greatly. There was a wide age range of people living at the service with diverse needs and abilities. The youngest person was in their 40s and the oldest was in their 70s.

As well as needing support with their mental health conditions, some people required more care and support related to their physical conditions. Some people were able to make their own decisions about how they lived their lives. They were able to let staff know what they wanted and were able to go out on their own.

The service had a registered manager. They started work at the service in July 2017 and registered with the Care Quality Commission (CQC) in December 2017. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run. The registered manager had not been working at the service full time for some months and was on a phased return working three days a week.

The last inspection was carried out on 7 July 2017. Concerns had been raised by whistle blowers and staff in the local safeguarding team. We found continued breaches of the regulations from our inspection on 13 December 2016. We also found new breaches of the regulations at the July 2017 inspection. The service was rated Inadequate in all domains and was placed in special measures. We took enforcement action and placed a restriction on the provider’s registration so that they could not admit any people to the service without prior written consent from the CQC.

The provider sent us regular action plans and updates with timescales stating when they would be compliant with the regulations. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Some improvements had been made, however we found some continued and a new breach of the regulations. This is therefore the fourth consecutive time the service has been rated Requires Improvement or Inadequate showing un sustained improvement.

At this inspection the provider had failed to comply with their action plan with persistent shortfalls including the way risk was managed, people’s involvement and engagement, governance, environmental risks, recruitment checks, training and induction of staff.

The registered persons continued not to have oversight and scrutiny to monitor and support the service. There was a lack of continuity in the leadership and management of the service, which had impacted on people, staff and the quality of the care provided. There were quality assurance systems in place, which included reviewing and updating care plans, audits, health and safety checks, but these had not identified the shortfalls found at this inspection. Some records could not be located, were not suitably detailed or accurately maintained. Previous breaches of regulations had not been addressed and the breaches continued. Poor record keeping was identified as a breach of the regulations at the last inspection and continued.

Risks relating to people's care and support had not always been assessed and mitigated. Improvements h

Phoenix House provides accommodation and personal care for up to 24 people who need support with their mental health needs. There were 19 people living at the service at the time of the inspection. The service is situated in its own extensive grounds and gardens in the rural village of Northbourne, which is close to the seafront towns of Deal and Sandwich.

The care and support needs of the people varied greatly. There was a wide age range of people living at the service with diverse needs and abilities. The youngest person was in their 40's and the oldest was in their 70's.

As well as needing support with their mental health, some people required more care and support related to their physical conditions. Some people were able to make their own decisions about how they lived their lives. They were able to let staff know what they wanted and were able to go out on their own.

The last inspection was carried out on 13 December 2016 when we found continued breaches of the regulations from our inspection on 3 November 2015. The service was rated 'Requires Improvement' and 'Inadequate' in the 'well-led' domain. The provider sent an action plan to CQC in February 2017 with timescales stating they would be compliant with the regulations by March 2017. At this inspection the provider had failed to comply with their action plan and there were continued breaches of the regulations relating to safe care and treatment, treating people with dignity respect that promoted their independence and autonomy, person centred care and good governance. There were also new breaches identified relating to need for consent, safeguarding people from abuse and proper treatment, staffing, not notifying the relevant bodies when incidents occurred at the service and complaints.

The service did not have 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 and associated Regulations about how the service is run.

The registered manager had left in March 2017. We contacted to the registered provider about this before the inspection. A new manager had been appointed in April 2017 but they left in June 2017. Another manager had been employed and they were due to start work at the service on 10 July 2017. In the meantime the provider’s business manager was supporting the service but was not at the service every day. The deputy manager of the provider’s other service was supporting the service. When we returned for the second day of our inspection we met the new manager.

The provider had not taken appropriate steps to ensure they had oversight and scrutiny to monitor and support the service. There was a lack of continuity in the leadership and management of the service, which had impacted on people, staff and the quality of the care provided. There were quality assurance systems in place, which included reviewing and updating care plans, audits, health and safety checks, but these had not been consistently undertaken. Records were not suitably detailed or accurately maintained. Previous breaches of regulations had not been addressed and the breaches continued.

Some people told us they did not feel safe at the service. People were not fully protected from harm and abuse. Incidents had occurred when people and staff had been hurt. The staff had not followed safeguarding protocols and incidences had not been reported to out-side agencies. Referrals had not been made to the local safeguarding authority when safeguarding incidents had happened. The staff had not informed CQC of important events that occurred at the service, in line with current legislation.

Potential risks to people were identified, like diabetes, choking and when people had behaviours that could be challenging. Full guidance on how to safely manage

Phoenix House provides accommodation and personal care for up to 24 people who need support with their mental health needs. There were 19 people living at the service at the time of the inspection. The service is situated in its own extensive grounds and gardens in the rural village of Northbourne, which is close to the seafront towns of Deal and Sandwich.

The care and support needs of the people varied greatly. There was a wide age range of people living at the service with diverse needs and abilities. The youngest person was in their 40’s and the oldest was in their 70’s years.

As well as needing support with their mental health, some people required more care and support related to their physical conditions. Most people were able to make their own decisions about how they lived their lives. They were able to let staff know what they wanted and were able to go out on their own.

The previous inspection of this service was carried out on 3 November 2015 when we found breaches of some regulations. The provider sent an action plan to CQC in December 2015 with timescales stating they would be compliant with the regulations by December 2015. At this inspection the provider had failed to comply with their action plan and there were continued breaches of the regulations relating to safe care and treatment, the recruitment of staff, treating people with dignity and respect that promoted their independence and autonomy and good governance.

There was a registered manager working at 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 and associated Regulations about how the service is run. A deputy manager had recently been appointed to support the registered manager.

At the previous inspection staff were not always recruited safely, at this inspection there still shortfalls. The provider had policies and procedures in place for when new staff were recruited, but these were not consistently followed. All the relevant safety checks had not been completed before staff started work.

Some care plans did not contain all the information needed to make sure people received the care and support that they needed. The process of reviewing and updating people’s care plans had fallen behind due to staff shortages and the registered manager had spent a lot of their time working with the care staff team to make sure people’s daily needs were met. A staff member had now been employed to make sure people’s care plans were reviewed and updated, however the care plans were written in negative way and indicated that staff controlled the way people behaved. People were not always empowered to have as much control and independence as possible with aspects of their lives. People had not been fully involved in reviewing their care plans and how they wanted to receive their care and support. People were not always treated with dignity and respect that promoted their independence and autonomy

Potential risks to people were identified, like diabetes, eating safely and when people had behaviours that could be challenging. Full guidance on how to safely manage the associated risks was not always available. This left people at risk of not receiving the support they needed to keep them as safe as possible. Accidents and incidents had been recorded and action had been taken to reduce any risks to people.

Generic emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do. However, personal emergency evacuation plans (PEEPs) were not adequate and did not contain information about people’s individual needs during an emergency evacuation. This was identified as breach of the regulations at the last inspection and continues to be a breach at this inspection. It had been identified that e

Phoenix House provides accommodation and personal care for up to 24 people who need support with their mental health needs. There were 19 people living at the service at the time of the inspection. The service is situated in its own extensive grounds and gardens in the rural village of Northbourne, which is close to the seafront towns of Deal and Sandwich.

The care and support needs of the people varied greatly. There was a wide age range of people living at the service with diverse needs and abilities. The youngest person was in their 40’s and the oldest was 74 years old.

As well as needing support with their mental health, some people required more care and support related to their physical health. Some people were able to make their own decisions about how they lived their lives. They were able to let staff know what they wanted and were able to go out on their own.

There was a registered manager working at 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 and associated Regulations about how the service is run.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). When people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare the registered manager had taken the necessary action. At the time of the inspection no-one at the service was subject to a DoLS authorisation but the registered manager kept this under review. There were records to show who people’s representatives were, in order to act on their behalf if complex decisions were needed about their care and treatment.

Before people decided to move into the service their support needs were assessed by the registered manager to make sure they would be able to offer them the care that they needed. The care and support needs of each person were different and each person’s care plan was personal to them. People or their relative /representative had been involved in writing their care plans. Most of the care plans recorded the information needed to make sure staff had guidance and information to care and support people in the safest way and in the way that suited them best. People were satisfied with the care and support they received. Potential risks to people were identified and guidance on to how to safely manage the risks was available. People were kept as safe as possible. People had regular reviews of their care and support when they were able to discuss any concerns or aspirations and goals they wanted to achieve.

People received their regular medicines safely and when they needed them and they were monitored for any side effects. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable. Some people needed medicines on a ‘when required’ basis, like medicines for pain or behaviours. There was no guidance or direction for staff on when to give these medicines safely and consistently. People were not always empowered to have as much control and independence as possible with their medicines. When people received their medicines from staff throughout the day they were not given the choice of where and how they preferred to have their medicines. People were not supported to be as independent as possible and their dignity was not respected when they were given their medicines.

On the whole people had their needs met by sufficient numbers of staff but there were times when there was not enough staff on duty to do allocated duties like the laundry and cleaning. Staff numbers were based on people’s needs, activities and health appointments. People received care and support from a dedicated team of staff that put people first and were able to spend time with people in a meaningful way.

Staff had support from the registered manager to make sure they could care safely and effectively for people. Staff said they could go to the registered manager at any time and they would be listened to. Staff had received regular one to one meetings with a senior member of staff. Staff had received an annual appraisal and had the opportunity to discuss their developmental needs for the following year. Staff had completed induction training when they first started to work at the service and had gone on to complete other basic training provided by the company. However, there were shortfalls in training in areas such as mental health awareness and challenging behaviours, which were areas very specific to people at the service. There were staff meetings so staff could discuss any issues and share new ideas with their colleagues to improve people’s care and lives.

Staff were not always recruited safely. The provider had policies and procedures in place for when new staff were recruited, but these were not consistently followed. All the relevant safety checks had not been completed before staff started work. Some files did not contain appropriate references and gaps in employment had not been explored when staff were interviewed. The registered manager took action to address this.

Generic emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do. However, personal emergency evacuation plans (PEEPs) were not adequate and did not contain information about people’s individual needs during an emergency evacuation. The checks for the fire alarms were done weekly and there were regular fire drills so people knew how to leave the building safely

There were policies and procedures in place to protect people’s finances. These procedures were in place to help people manage their money as independently as possible and spend their money to assess activities and going out in the community. The staff were not fully adhering to the company’s policies and procedures when they took people out for meals. We found that, on occasions, staff took people out for meals and they were using people’s money to pay for staff meals and drinks as well. The registered manager told us this should not be happening and immediately took action to reimburse people. Clear accounts of all money received and spent were available. Money was kept safely and was accessed by senior staff. People could access the money they needed when they wanted to.

People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns both within the company and to outside agencies like the local council safeguarding team. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed. The registered manager responded appropriately when concerns were raised. They had undertaken investigations and taken action. The registered manager followed clear staff disciplinary procedures when they identified unsafe practice.

Accidents and incidents had been recorded and action had been taken to reduce any risks to people, however, these were not analysed to identify any patterns or concerns to reduce the risk of them happening again.

People had an allocated key worker. Key workers were members of staff who took a key role in co-ordinating a person’s care and support and promoted continuity of support between the staff team. People had key workers that they got on well with. The service was planned around people’s individual preferences and care needs. The care and support they received was personal to them. Staff understood people’s specific needs. Staff had built up relationships with people and were familiar with their life stories, wishes and preferences. This continuity of support had resulted in the building of people’s confidence to enable them to make more choices and decisions themselves and become more independent.

People were involved in activities which they enjoyed. Some people were able to go out daily and do what they wanted to in the local area. People went on trips to places that interested them and went to social clubs to meet up with friends. People did art and crafts, as well as other leisure activities within the service. People talked animatedly about social events they had taken part in or were planning. Contact with people’s family and friends who were important to them was well supported by staff. Staff were familiar with people’s likes and dislikes, such as if they liked to be in company or on their own and what food they preferred. Staff knew how people preferred to be cared for and supported and respected their wishes.

People said that they enjoyed their meals. People were offered and received a balanced and healthy diet. They had a choice about what food and drinks they wanted. If people were not eating enough or needed specialist diets they were seen by dieticians or their doctor and a specialist diet was provided.

The complaints procedure was on display in a format that was accessible to people. Feedback from people, their relatives and healthcare professionals was encouraged and acted on wherever possible. Staff and people told us that the service was well led and that the management team were supportive and approachable. They said there was a culture of openness within Phoenix House which allowed them to suggest new ideas which were often acted on.

There were quality assurance systems in place. Audits and health and safety checks were regularly carried out by the registered manager and the quality assurance manager from the company’s head office. The registered manager’s audits had not identified some shortfalls that were identified during the inspection.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

There were 19 people using the service and we met and spoke with some of them. Some people had gone out into the community and others were planning to go out. People said or indicated that they were happy with the service. One person said “It is nice here, I like it here.”

Improvements had been made to the care planning process following our last inspection. Everyone now had a care plan, including risk assessments, detailing their needs and giving up to date guidance to staff.

The quality assurance process had been improved. Regular monitoring, audits and checks by the provider ensured the service was safe. People’s views about the service were being sought and acted on.

People’s hobbies and interests were supported and people had support to access the community and take part in community based activities. People were supported to plan their holidays and days out.

People maintained good health and mental health because the service worked closely with health and social care professionals. The home was safe and well maintained and suited people’s needs.

Checks were made on staff, as part of the recruitment process, to make sure that people were safe and supported by appropriate people. One person told us “The staff are very nice, they try to be helpful.”

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not all able to tell us their experiences.

We spoke with three people living at the home. One person told us that they did not want to live at the home. Another told us that they were happy and had chosen all the possessions in their room. We saw limited interaction between staff and people.

We found that there were care plans, health files and person centred plans in place for most people that used the service and that these were regularly reviewed and changes made as necessary but this was not consistent.

The manager was not available at the time of our visit and so we spoke to staff and a visiting manager who was present. Not all staff records were available for us to see and we saw gaps in training for staff. We saw that the service had some methods to records peoples views about quality.

The people we spoke to said that they were treated with kindness and respect. They said that they received the support they need and that they had been consulted about decisions that had affected them. People said that they felt safe. They said that they liked their meals. People were confident any complaints they made would be listened to and acted on.