Horizon Homecare (Southern) Ltd

Horizon Homecare (Southern) Ltd is a domiciliary care service providing a regulated activity of personal care. The service was providing care and support to people in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection there were 217 people receiving personal care from the service.

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

Significant improvements had been made within the service. Systems and processes had been introduced and existing ones strengthened to ensure safety, quality and oversight. Improvement work was ongoing, and some systems needed to embed through the service.

People and their relatives told us Horizon Homecare (Southern) Ltd was a safe service. Staff told us overwhelmingly that improvements had been made to all aspects of the service especially in the past six months and they had confidence in the management team.

Medicines were managed safely, and people received their medicines as prescribed. Recording and staff training around medicines safety was improved. People’s risks had been identified, assessed and steps taken to mitigate harm. Staff knew people well. Work to improve the detail and quality of assessments was ongoing.

The service had reduced its care hours to ensure it had enough staff to complete visits to people safely. The introduction of an impact risk assessment, which was completed before a decision was made whether to accept or decline a new person to the service, meant this was only done when safe. A detailed pre assessment was completed for each person prior to the service starting and this ensured the service could meet their needs. Staff were safely recruited and there were many new roles introduced to strengthen the service and improve safety. Infection prevention and control procedures were clear, and staff followed them.

Improved staff compliance with the electronic care planning system meant that management staff had better oversight and information about people’s care and support needs were up to date. Frequent spot checks and supportive supervisions were held to maintain quality of service. Staff told us they felt supported and had access to a wide range of training and guidance in order for them to carry out their role well. The service was supported by a reliable out of hour on call service, staff told us this was an improvement in the past few months.

Where people were supported with food and drink this was done as planned and detailed records meant intake could be monitored where necessary. People had access to healthcare services as required and the service worked well with external professionals. People knew how to make a complaint and records showed complaints and concerns were dealt with.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff received training in the Mental Capacity Act 2005 (MCA) and understood the importance of gaining consent before supporting people. People’s communication needs were known and recorded in their care plans. Care plans were detailed, person centred and in line with their specific individual health needs.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic. We found that Horizon Homecare (Southern) Ltd was working within the principles of, ‘Right support, right care, right culture.’

Governance systems had been established and were operating effectively and the service was working on ensuring the improvements were embedded. People, relatives and staff knew the registered manager and felt confident any concerns raised would be dealt with. Staff were clear on their role and responsibilities. The registered manager kept themselves up to date and had a clear plan for the service. People had been asked for their input and feedback on the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 29 March 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 29 March 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Horizon Homecare (Southern) Ltd is a domiciliary care service. It provides personal care to adults living in their own homes in the Swanage, Poole, Bournemouth and Christchurch area. This includes a team of twilight staff, who provide night visits across the area. There were around 349 people using the service at the time of the inspection. Not everyone using the service receives regulated activity; CQC only inspects the service being received by people provided with 'personal care', help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

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

People had varied experiences of Horizon Homecare (Southern) Ltd. Whilst we received some feedback from people who told us they felt safe and happy with the service provided, other people told us they felt unsafe and we identified areas the service needed to improve to ensure people received safe, effective and responsive care according to their individual needs.

The service did not have robust systems to identify when people’s care calls were late or missed. This had led to people not receiving care calls and had placed people at risk of harm. Staffing levels were unsafe and did not meet the needs of the people using the service, yet the service had continued to take on new packages of care. People’s care calls were often cut short and staff were sometimes booked to be in two or three places at once.

Medicines were not managed safely. The service had failed to identify low stocks of medicines, where staff were responsible for ordering, and where people had missed doses of medicines. Risks associated with high risk medicines had not been assessed and staff lacked the skills to manage these safely. The service could not provide assurances that people had been given their medicines as prescribed.

Risks to people had not always been assessed and where risks had been identified, staff did not have clear instructions on how to support people with those risks. People were at risk from the spread of infection, as the provider had not fully assessed and managed the risk of this.

The service had not always identified incidents as safeguarding concerns and had not appropriately reported safeguarding concerns to the local authority. This placed people at risk of not having safe care and treatment.

People's nutrition and hydration needs had not always been met. This had placed people at risk of malnutrition and dehydration.

People told us the care staff they knew well were friendly and caring but did not feel safe when these carers were not on duty. A relative said, “It is a different story when the usual carer has a day off or holiday, you never know who is coming or at what time. This is very disconcerting for an elderly person who needs to be reassured.” Some people had not always been treated with dignity and respect.

Robust systems and processes were not in place to ensure people were receiving care according to their needs. There were not enough staff to safely meet every person’s care needs. Complaints had not always been investigated and responded to. This resulted in people’s care needs not always being met and placed people at risk of neglect.

The provider had failed to monitor the quality of the service. This meant areas of improvement were not identified and people had been placed at risk of harm.

Staff felt listened to and supported in their job roles. Staff said the induction and training was informative.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, Right care, Right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was supporting only a small number of people who had a learning disability and or/autism. We looked at the care they received and found the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support – The service worked with people, their family and social workers to maximise people’s choice, control and independence.

Right Care – The service carried out regular reviews with people with a learning disability and/or autism and requested input from their social workers to ensure the right package of care was in place.

Right Culture – Staff empowered people with a learning disability and/or autism to lead their lives with confidence.

Since the inspection the provider has sent CQC an action plan to demonstrate how they will reduce the risk of missed and late care visits to people using the service. The provider has given assurances that medicines are being reviewed to ensure people receive medicines as prescribed. The provider has been open throughout the inspection and acknowledged the areas identified in the inspection need improving. The provider made the decision to not take on any new packages of care until such time the service has managed to put effective systems in place to oversee and monitor the quality of the service delivery.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 22 June 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. The information CQC received about the incident indicated concerns about the management of care delivery. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We sought urgent assurances around missed and late visits and the safe management of medicines. The provider gave assurances that systems and processes have been put in place to mitigate the risk of missed and late visits and medicines are being reviewed to ensure people’s medicines are administered safely. The provider told us they were working with specialist consultants to provide medicine training for all staff and were arranging for the in-house trainer to undertake a medication “train the trainer” course to ensure staff training is reviewed and kept up to date.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to person-centred care, dignity and respect, safe care and treatment, safeguarding people from abuse, receiving and acting on complaints, good governance, staffing and notification of other incidents to CQC.

Please see the action we have told the provider to take at the end of this report.

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

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

At our last inspection we rated the service good overall, but requires improvement in Responsive as there was a breach in the legal requirements relating to person-centred care.

At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. The service met all relevant fundamental standards. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

As required under the conditions of its registration, the service had a registered manager, who was also the owner of the company that owns it. 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.

There were systems operating to help protect people against abuse and avoidable harm. Risks were identified and managed so that people were protected from harm. Medicines were managed and administered safely. Staff followed infection prevention and control procedures.

There were systems in place for responding to emergencies, including an out-of-hours on call service.

Staff were recruited safely, following checks that staff were of good character and suitable for their role. There were sufficient appropriately trained and skilled staff to provide people’s care. Staff did not always have sufficient travel time allocated between calls that were more than a short walk apart. However, no-one told us they did not receive the care they needed or felt rushed as a result. Action was under way to address this.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s physical, mental health and social needs were assessed and provided for holistically. Care plans were comprehensive and were kept up to date. The service liaised with other organisations to ensure people received the care they needed and that they had support to manage their health. People were supported to maintain a balanced diet and to drink enough, where this formed part of their care package.

The service provided care packages for people at the end of life. They worked as part of a team with people’s community healthcare professionals and other agencies to ensure people received the care they needed.

Staff treated people with kindness and compassion and promoted their independence. People spoke highly of their regular care workers, who they felt understood them well and attended to how they liked things to be done.

Some people said they had experienced different workers and calls that were not at their preferred time. The service was aware there had been issues and was taking action to address these, including the allocation of workers to postcode districts and the maintenance of a ‘waiting list’ for calls at preferred times.

Complaints were investigated promptly and outcomes recorded.

The culture of the service was open, transparent and person centred. There was a willingness to speak with people and their relatives when things went wrong, and to bring about any improvements that were necessary.

The registered manager, who also owned the provider company, adopted a hands-on approach.

Staff knew how to raise concerns and felt these would be taken seriously. Staff meetings were held regularly, and staff were also supported through supervision.

Governance systems were in place to ensure the service remained safe, effective, caring and responsive to people’s needs. However, people did not all recall anyone from the office visiting or telephoning them to ask if they were happy with the service.

We recommend the service reviews and maximises the opportunities it has to obtain feedback from people.

The service worked in partnership with other agencies to ensure it remained sustainable

Further information is in the detailed findings below.

We spoke with the manager and two care staff as well as checking five care plans and three staff records. We found that systems had been reviewed and new documentation had been introduced. This meant that people's needs were fully assessed and planned for and that staff were recruited in a robust manner to ensure that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

People who use the service told us that their care workers always checked what care was required and how they should do this. Care plans and assessments were also signed by people or their representatives to confirm that they consented to receiving help from the agency.

People told us that they liked the care workers that came to help them. They said that they were well cared for and the staff were kind and helpful.

We found that the agency had not carried out some needs assessments and risk assessments relating to people's care needs. This meant that they may not have identified some areas of need or taken action to reduce risks.

Staff were up to date with training and were knowledgeable about protecting vulnerable people from abuse. The service also had a system in place to respond to ensure that complaints were listened to, recorded and responded to appropriately.

We found that staff recruitment procedures had not always been followed. This meant that not all of the required checks on people to ensure their suitability to work with vulnerable people had been carried out.