Horizonz Care Ltd

Horizonz Care Ltd is a domiciliary care agency providing personal care and support to people in their own homes. Horizonz Care Ltd provides a service to older people and younger adults. At the time of inspection, the service was providing personal care to 28 people.

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

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

Systems and processes were in place to safeguard people from the risk of abuse. People told us they felt safe. Staff knew how to respond to accident and incidents.

Care plans and risk assessment were detailed and set out how people wanted to be supported. People received care in a person-centred way. People were supported to take their medicines safely.

Managers and staff understood their roles and responsibilities. There was enough staff working within the service to meet people's needs. People spoke positivity about the care they received from the staff. Systems were in place to monitor calls, making sure visits had been completed. Senior carers carried out spot-checks on staff. The provider had a service improvement plan to drive improvements at the service. People did not have any complaints, and if they did, they knew how to complain. The provider took opportunity to get feedback from others.

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.

Rating at last inspection

The last rating for this service was requires improvement (published 10 January 2020) and breaches of regulation were identified.

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.

Why we inspected

The inspection was prompted due to concerns received about staffing, length of calls and quality of care. As a result, we undertook a focused inspection to review the key questions of Safe and Well led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Follow up

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

People's experience of using this service

At the last inspection in August 2018 we rated the service requires improvement. We found two breaches of regulation, one relating to unsafe staff recruitment practices and one because governance systems were not effective. At this inspection we found improvements had been made to staff recruitment processes, however the registered provider did not always have effective systems of governance in place to maintain and improve the quality and safety of the service.

People and relatives provided good feedback about the service and people told us they felt safe. Staff had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse had taken place.

Incidents were usually recorded, and action taken to keep people safe, however missed visits were not always recorded as incidents and the registered provider did not have an effective overview of these incidents.

Staff knew what to do in the event of an emergency. Risk assessments were individualised and minimised risk whilst promoting independence.

People we spoke with told us staff were usually on time and they had not experienced any recent missed care visits.

Staff were supported with an induction, supervision and role specific training, which ensured they had the knowledge and skills to support people. People received support with their meals if this was part of their care plan.

People received support to maintain good health and were supported to access healthcare professionals and services if required.

People had maximum choice and control of their life and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us staff were caring and supported them in a way that maintained their dignity, privacy and independence. People were involved in planning their care and were supported with social activities if this was part of their care package.

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 requires improvement (published 13/10/2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of one regulation.

The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

We have identified a breach in relation to governance of the service at this inspection.

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

Why we inspected

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up

We will request an action plan and meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will continue to monitor the service and re-inspect in line with the current rating. If we receive any concerning information we may inspect sooner.

We visited the provider’s office on the 29th August 2018 and made phone calls to people, staff and relatives between the 17 August and 7 September 2018. The inspection was announced. This meant we gave the provider a short amount of notice that we would be visiting.

At the last inspection in July 2017 we rated the service Requires Improvement. We found two breaches of regulation, one relating to unsafe recruitment practices and the other as the service was not acting within the legal framework of the Mental Capacity Act (MCA). At this inspection we found overall, the service was acting within the legal framework of the MCA and obtaining consent lawfully with improvements evident in this area. However, we found safe recruitment practices were still not being followed which meant the service was still in breach of this regulation. Because the provider had failed to improve in this area we also concluded governance systems were not effective. This led us to also find the provider in breach of another regulation relating to Good Governance.

We also found there were many areas where the service performed well. People and relatives provided good feedback about the service. They said they received good, personalised care from kind and caring staff. People said they had familiar care workers who knew them well. People said the management team were warm and friendly and willing to address any issues they had. We found the management team and staff to have good caring values and demonstrated a commitment to providing people with personalised care and support.

People said they felt safe using the service. Risks to people’s health and safety were assessed and clear risk assessments produced for staff to follow. Staff knew people well and how to care for them. Action was taken following incidents and accidents to help keep people safe.

People received appropriate support with their medicines and clear records were kept to evidence this.

There were enough staff deployed to ensure people received a timely and reliable service. Staff said they did not have to rush and had time to complete care tasks to a high standard. However staff were not always recruited safely, as references had not always been obtained for new staff from previous employers. Staff received a range of training and support relevant to their role.

People said they received appropriate support at mealtimes. People’s care needs were assessed and detailed plans of care were put in place. These were personalised and provided staff with clear instructions on how people liked their care to be delivered. The service worked with health professionals to help ensure people’s healthcare needs were met.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

People said they were treated with dignity and respect by staff. People had a small group of care workers who got to know them well. New staff were introduced to people before they worked with them.

People said they felt listened to and valued by staff. Any complaints or issues were dealt with appropriately.

Audits and checks were undertaken by the service. However, these were not always thorough enough as they did not always pick up errors in care documentation. Systems and processes should also have been operated to ensure improvements were made to recruitment practices.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities )2014 Regulations. You can see what action we asked the provider to take at the back of the full version of this report.

Horizonz Care is a domiciliary care agency that provides personal care for people living with dementia, mental health needs, physical, sensorial and learning disabilities in their own homes. At the time of this inspection they were supporting 25 people.

There was a registered manager in place. 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.

At the last inspection the service was rated required improvement and had two breaches of regulation related to safe care and treatment and good governance. At the last inspection on 08 August 2016, we asked the provider to take action to make improvements to their processes in relation to supporting people with medication and good governance. At this inspection we found that the service had made improvements and was no longer in breach of regulation for safe care and treatment in good governance. However, we found the service was breaching regulations concerning safe recruitment and consent.

People who used the service were protected from the risk of harm and abuse. There were policies in place in relation to safeguarding and whistleblowing procedures. Care workers understood these policies.

People's risks had been assessed and there were plans in place to minimise and manage those risks.

New employees were checked before they could work with people but this practice was not always consistent.

People told us that care workers turned up on time to provide care and there were enough care workers to support people.

People’s medicines were not always managed safely. People and their relatives told us that medication was given on time and not missed. There were no protocols for ‘as and when’ required medication or creams. We found that staff’s competencies and medication audits were not robust.

Care workers completed an induction to ensure they were aware of their roles and duties. They were provided with regular supervisions to assess and monitor their performance and wellbeing.

People told us they were treated with respect and dignity. They said they were always given a choice and care workers respected their decision.

People's support needs were assessed prior to receiving support from the service. Care plans were detailed and personalised to people’s care needs and preferences.

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

The registered manager was able to explain their responsibilities under the Mental Capacity Act 2015 however, we found inconsistency in the mental capacity assessments sampled; some were very detailed but others were not decision specific.

People and their relatives told us they thought the service was well managed. We found there were arrangements in place to monitor the quality of the service but these were not all equally robust.

The registered provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked to see if improvements had been made.

Horizonz Care is registered to provide personal care. Care and support is provided to people who live in their own homes within the localities of Dewsbury and Huddersfield. On the day of our inspection 26 people were receiving support with personal care.

The registered provider is also the registered manager for 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 2008 and associated Regulations about how the service is run.

People told us they felt safe. Staff had received training in safeguarding vulnerable people and were able to tell us the action they would take in the event of anyone being at risk of harm or abuse.

A number of risk assessments had been implemented since our last inspection, these included details of the equipment staff needed to use to enable safe moving and handling of people. Emergency contact information was recorded in each of the care plans we reviewed but this information did not record the location of emergency cut off points for the utility services in people’s homes.

Our inspection on 6 January 2016 found that recruitment procedures were not thorough. At this inspection we found some improvements had been made, for example Disclosure and Barring Service (DBS) checks were recorded for staff. As no new staff had been employed since our last inspection we were unable to evidence safe recruitment procedures had been implemented by the registered provider.

People told us staff were on time and did not miss calls. The registered person told us they implemented an electronic monitoring system; this alerted them in the event a person’s call was late or had been missed.

Staff had completed medicines training but the document used to assess staff competency in medicine administration lacked detail. Improvements had been made to the recording of people’s medicines but we saw gaps on medicine records and not all the entries contained adequate information to enable safe administration by staff. This evidenced a continuing breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Since our last inspection staff had completed a variety of online training courses. They had also attended a practical training session for moving and handling of people. Staff had received supervision, although this was not always documented.

Staff we spoke with understood people’s right to make decisions about their daily lives. Where people lacked mental capacity, assessments were in place in their care plans, however, these needed further development to ensure they were specific to the decision they related to.

Where people were unwell, we saw evidence they had been supported to receive medical advice.

People told us staff were kind and caring. Staff spoke to us in a caring manner about the people they supported. Staff were able to describe the steps they took to ensure people’s privacy and help them to retain a level of independence.

Records relating to people and staff were stored securely.

People had a care plan in place. Staff said the care plans were reflective of people’s current care needs and we saw evidence care related records were reviewed and updated.

Not all documents were dated and due to the volume of records, including archived records in files it was not easy to identify the current care planning records.

All contact with the office regarding people who used the service was logged, however, due to the method of recording and lack of analysis; it was difficult to see if there were any trends or themes.

Staff told us the service had improved since the last inspection.

Audits had taken place but these were random and there was no set criteria for which medicine records and daily call logs were checked against. There was no information regarding the frequency or outcomes of audits. Spot checks were completed on staff performance and feedback was gained from staff and people who used the service. However, there was no analysis of the results or evidence the findings were shared. This demonstrated a continuing breach of Regulation 17 of the Health and Social Care Act 2008 Regulations.

You can see what action we told the provider to take at the back of the full version of the report.