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Inspection carried out on 15 November 2017

During a routine inspection

The Horizon is a residential care home which provides care and support to a maximum of eight people with mental health needs. At the time of this inspection there were five people using the service.

This inspection took place on 15 November 2017 and was unannounced.

At the last inspection on 8 July 2015 the service was rated ‘Good’.

At this inspection we found the service remained ‘Good’.

People and relatives confirmed that they and their relative felt safe living at the Horizon and were happy with the care and support that they received. Care staff demonstrated a clear understanding of the term ‘safeguarding’ and were able to explain the steps they would take to report any concerns.

The service identified each person’s individual risks associated with their care, support and health needs. Detailed risk assessments had been devised giving detailed information on how each person’s identified risk was to be managed or mitigated against in order to keep people safe.

Appropriate systems and processes were in place to manage people’s medicines safely.

People’s needs had been assessed prior to admission to the home and continued to be assessed whilst living at the home to ensure that the service was able to appropriately meet their specific needs and requirements.

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

Care staff told us and records confirmed that they received appropriate training and support which enabled them to carry out their role safely and effectively.

Safe recruitment practices had been followed ensuring that staff employed by the service had been assessed and deemed as safe to work with vulnerable adults.

We observed people receiving care and support that was personal to their needs and requirements. This had also been clearly documented within people’s care plans.

Care plans were person centred and gave detailed information about the person, their life history and how they wished to be supported. Care staff knew people very well and were clearly aware of their needs and preferences.

People and care staff confirmed that the registered manager and deputy manager were always available and visible around the home. Appropriate management oversight systems were in place to monitor the quality of care being delivered.

Appropriate systems were in place to manage complaints.

People were supported to engage in social activities and personal hobbies where appropriate. People were also supported to develop and maintain independence.

Further information is in the detailed findings below.

Inspection carried out on 8 July 2015

During a routine inspection

This inspection took place on 8 July 2015 and was unannounced. The Horizon provides care and support to a maximum of eight adults with mental health needs. At the time of our inspection, there were six people using the service.

At our inspection on 4 June 2014 the service did not meet regulation 23 of the Health and Social

Care Act 2008 (Regulated Activities) Regulations 2010 because staff had not received appropriate support through supervisions and appraisals. Our inspection on 8 July 2015 found that the service had made improvements in respect of supporting staff and regulation 23 had been met.

There was a registered manager in post 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 who used the service told us they felt safe in the home and around staff. Relatives of people who used the service told us that they were confident that people were safe in the home. Systems and processes were in place to help protect people from the risk of harm. These included careful staff recruitment, staff training and systems for protecting people against risks of abuse.

Positive caring relationships had developed between people who used the service and staff and people were treated with kindness and compassion. People were being treated with respect and dignity and staff provided prompt assistance but also encouraged people to build and retain their independent living skills.

People told us that they had been given their medicines as prescribed. There were arrangements for the recording of medicines received into the home and for their storage, administration and disposal of medicines. However, we noted that regular temperature checks had not been carried out to ensure that medicines were stored at the right temperature. We also found that medicine audits were not documented and therefore there was no evidence that these took place.

There were enough suitably trained staff to meet people’s individual care needs and this was confirmed by staff we spoke with. Staff spoke positively about the training that they had received.

Staff had the knowledge and skills they needed to perform their roles. Staff spoke positively about their experiences working at the home. Staff told us that they felt supported by management within the home and said that they worked well as a team.

Care plans were person-centred, detailed and specific to each person and their needs. People were consulted and their care preferences were also reflected. People’s health and social care needs had been appropriately assessed. Identified risks associated with people’s care had been assessed and plans were in place to minimise the potential risks to people.

Staff received training in the Mental Capacity Act 2005 and were able to demonstrate a good understanding of how to obtain consent from people. Staff we spoke with understood they needed to respect people’s choice and decisions if they had the capacity to do so.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. No DoLS applications had been submitted as people were not restricted.

The service had an open and transparent culture where people were encouraged to have their say and staff were supported to improve their practice. We found the home had a clear management structure in place with a team of care staff, the deputy manager and the registered manager. There was a system in place to monitor and improve the quality of the service which included feedback from people who used the service, staff meetings and a programme of audits and checks.

We found the premises were clean and tidy. The home had an Infection control policy and measures were in place for infection control. There was a record of essential inspections and maintenance carried out.

Inspection carried out on 4 June 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to gather evidence to answer five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

During this inspection we spoke with three people who used the service and three relatives of people who used the service. We also spoke with five members of staff who included the Registered Manager and care support workers.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Three people who used the service told us that they felt safe in the home and that staff treated people with respect and dignity. One person told us, �Staff are very courteous and polite. They talk to me with respect and dignity�. Relatives of people told us that they were confident that people living in the home were safe. One relative told us, �Staff are very friendly. They listen, are polite and respectful�.

The home had a safeguarding policy which included guidelines on how staff should respond and act if they suspected abuse was taking place. At the time of our inspection, we noted that the policy was in need of updating. Following the inspection, the provider updated their policy and sent us evidence of this.

We looked at the training records for three members of staff and noted that the records indicated that they had received safeguarding training. The provider explained that the training had been provided by the local authority. When we discussed safeguarding with staff, they were aware of the signs of abuse and the action to take when responding to allegations or incidents of abuse. Staff were also aware that they could report allegations to the local authority and the police. However, not all staff were aware that they could report such allegations to the Care Quality Commission.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. However, staff did not receive appropriate supervisions and appraisals which enabled them to perform their work appropriately and ensure people using the service were safe and protected.

Is the service effective?

People we spoke with said that they were satisfied with the care provided in the home and felt that people's needs had been met. One person said, �The care is very good� and another person said, �It�s good here. I am happy with it�. Relatives were positive about staff and said that they were helpful and listened to them. One relative told us, "I have confidence in the staff� and another relative said, �Staff know what they are doing�.

We looked at three care files and saw that people's care needs had been assessed and care and treatment were planned and delivered in line with their individual care plan. Risk assessments had been carried out where necessary. Care plans included information about people's preferred routines and healthcare needs.

All the staff we spoke with told us that they were well supported by the Registered Manager and felt able to ask the Registered Manager questions. One member of staff said, �If I have any concerns, I can raise them with the manager. The manager is approachable�. However, staff had not received appropriate supervisions and appraisals.

Staff had received appropriate training in various areas to meet the needs of the people living in the home. However, there were areas of training that were outstanding for some members of staff.

Staff, family members, healthcare and social care professionals were involved in decisions about people's care and we saw evidence of this. Relatives of people who used the service told us that they were kept informed about people's progress.

Is the service caring?

People we spoke with were positive about the staff at the home. They told us that they had been treated with respect and dignity in the home.

During our inspection, we found that people who used the service approached staff without hesitation and people appeared comfortable around members of staff. There was good interaction between staff and people. People looked well cared for and we saw that the atmosphere was relaxed in the home. We saw that care staff were patient and supported people to meet their needs.

Staff we spoke with said that they were aware that all people should be treated with respect and dignity and were able to give us examples to demonstrate how they ensured this.

Is the service responsive?

People who used the service and relatives we spoke with told us that if they had any concerns or complaints, they would feel comfortable raising them with staff or the management at the home.

We saw that the home had a complaints policy and procedure and kept a record of complaints received.

Staff told us that the management at the home listened to them and welcomed feedback from them.

People's care and health progress were monitored closely. People's care plans and their health needs were regularly reviewed.

Is the service well-led?

At the time of our inspection, we found that adequate arrangements were not in place for monitoring and reviewing the quality of the service provided to people. The provider did not have a quality assurance policy and procedure and there was no evidence that questionnaires were sent to all people who used the service and their relatives. Following our inspection, the provider sent us their quality assurance policy and procedure.

People who used the service told us that staff and the Registered Manager listened to them.

Resident's meetings were held monthly which enabled people to discuss issues regarding the running of the home. This encouraged people to raise queries and concerns with management and members of staff.

Staff told us that staff meetings took place quarterly. We noted that staff had not received regular formal supervisions and there was no evidence that staff had received appraisals.

All staff we spoke with told us that they felt able to consult the Registered Manager if they had concerns or queries and said that they felt supported. Staff were positive about working at the home.

Inspection carried out on 21 May 2013

During a routine inspection

During this inspection we met the six people using the service and spoke with four people. We also looked at the most recent reviews of people, carried out by their placing authority and the service.

People we spoke with confirmed that staff communicated well with them and asked for their permission before any care or treatment took place. They told us that staff would always respect their wishes and preferences. People told us they felt involved in their care.

People were positive about the care and support they received from staff at the home. They confirmed that staff assisted them when they needed support and that staff were very helpful. They told us they were satisfied with the support they received to take their medication. They told us that staff explained what the medication they were taking was for if they didn�t already know. One person told us �it keeps me well.�

People told us they had no complaints about the service but knew how to make a complaint if they needed to.

Effective recruitment and selection processes were in place and appropriate checks were undertaken before staff began work.

Reports under our old system of regulation (including those from before CQC was created)