Horizon Homecare (Southern) Ltd was rated Inadequate overall following a January–February 2022 inspection, with breaches across eight regulations including unsafe medicines management, missed and late visits, inadequate staffing, and a failure to identify or report nine safeguarding incidents. Governance was severely deficient, with no registered manager in post and no effective systems to monitor quality, leading to the service being placed in special measures.
Concerns (13)
criticalMedication management: “one person should have taken an antipsychotic medicine daily but had not had it for 13 days. The system was not robust and had failed to identify low stock and missed medicines.”
criticalMissed or late visits: “Eleven relatives told us that their loved one had their visits missed; seven relatives reported multiple missed visits.”
criticalStaffing levels: “Staffing levels were unsafe and did not meet the needs of the people using the service. The provider...had continued to take on new packages of care.”
criticalSafeguarding: “We found nine safeguarding incidents during the inspection that had not been identified by the service...The service had not made appropriate referrals to the local safeguarding team.”
criticalGovernance: “The provider was not aware of the concerns found during the inspection that had led to people being at risk of not having their needs met and at risk of harm.”
criticalCare planning: “A person with a diagnosis of epilepsy did not have specific seizure risk assessments. Their care plans did not include guidance to tell staff what triggers may lead to a seizure.”
moderateComplaints handling: “We found written records of complaints being phoned into the service by relatives which had not been investigated and responded to.”
moderatePerson-centred care: “The service sent male care staff to people who had requested female only staff...relatives told us they had not been contacted and this had caused distress.”
moderateIncident learning: “Accidents and incidents were not analysed, and concerns were not always investigated. This meant the service did not learn from concerns, accidents, incidents and adverse events.”
moderateInfection control: “Risks to people's health and welfare had not been assessed in relation to infection prevention and control. Staff were not all taking part in routine COVID-19 testing.”
moderateRecord keeping: “Medication Administration Records (MAR) were not always accurate, kept up to date or completed in accordance with best practice guidance.”
moderateCommunication with families: “This business does not communicate effectively...They need someone on call, not just for us to leave a message, it could be an emergency.”
moderateLeadership: “There was not a registered manager at the time of the inspection...The structure of the service was not clear. Job roles did not accurately reflect staff responsibilities.”
Strengths
· Staff felt listened to and supported in their job roles and described induction and training as informative.
· Recruitment systems were robust with appropriate DBS and other pre-employment checks carried out.
· The service had a dedicated welfare team to seek medical advice and liaise with healthcare professionals.
· People were supported in line with MCA principles; consent was sought and best interests decisions recorded where needed.
· Staff had plentiful access to PPE and people confirmed staff wore it appropriately.
Quality-Statement breakdown (18)
safe: Using medicines safelyInadequate
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongInadequate
safe: Staffing and recruitmentInadequate
safe: Preventing and controlling infectionRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseInadequate
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
responsive: Improving care quality in response to complaints or concernsInadequate
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: End of life care and supportNot rated
well-led: Promoting a positive culture; duty of candour; working in partnership with othersInadequate
well-led: Managers and staff being clear about their roles; continuous learning and improving careInadequate
Horizon Homecare (Southern) Ltd improved significantly from its previous Inadequate rating and was removed from Special Measures, with breaches of regulations 9, 12, 13, 14, 16, 17, and 18 all remediated. However, the service remained Requires Improvement overall due to ongoing embedding of governance systems and visit punctuality issues, warranting continued CQC monitoring.
Concerns (3)
moderateMissed or late visits: “people told us visits were not always delivered on time as planned. The registered manager told us they were working on improving visit times”
moderateGovernance: “Governance systems had been established and were operating effectively and the service was working on ensuring the improvements were embedded.”
moderateStaffing levels: “unplanned sickness and absence was a challenge... the service had significantly reduced the number of people using the service”
Strengths
· Medicines managed safely with dedicated 'Welfare administrators' team overseeing medicines alerts and queries daily
· Robust safeguarding tracker introduced with clear details, actions taken and outcomes for each concern raised
· Electronic care planning system improved management oversight and kept care information up to date
· Detailed, person-centred care plans including risk assessments, nutrition, communication and end of life care
· Staff felt well supported with access to wide range of training including specialist training for learning disability and autism
Quality-Statement breakdown (20)
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Preventing and controlling infectionRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experience
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 230 people receiving personal care from the service. Learning from events and continual improvement were instrumental to the service. Leadership was visible and staff had committed to a common goal, to provide high quality care to people using the service. Governance systems were operating effectively and underpinned by robust policies and procedures.
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Good
effective: Staff working with other agencies; Supporting people to live healthier lives and access healthcareGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Planning personalised care to ensure people have choice and control; End of life care and supportGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirements; Continuous learningRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Engaging and involving people, the public and staff; Working in partnership with othersRequires improvement