7 October 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection was carried out by one adult social care inspector and some telephone calls were carried out by an expert by experience. An expert by experience is a person who has experience of using or caring for someone who uses this type of care service.
Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at the information in the PIR and also looked at other information we held about the service before the inspection visit.
In the course of the inspection we met three people who used the service and one relative. We spoke with a further eight people and three relatives, on the telephone.
We also spoke with seven members of care staff and received comments about the service via email from five other care workers. The registered manager/provider and director were available throughout the inspection. We met with four office assistants and the company secretary, the rota manager and assistant rota manager, training and HR manager and a community manager.
We looked at records which related to seven people’s individual care and other records related to the running of the service. Records included seven care and support plans, quality assurance audits and questionnaire results, staff training records, complaints and three staff recruitment files.
7 October 2017
The inspection was announced and took place on the 6 and 8 September 2017. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available in the office. It also allowed us to arrange to visit people receiving a service in their own homes.
This is the first inspection of the service since it was re-registered with a new location address with the Care Quality Commission in August 2016.
Horizon Care (South West) Limited is registered for the regulated activity ‘personal care.’ At the time of the inspection they provided personal care to around 280 people living in their own homes.
There is a registered manager in post who is also the provider. 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.
The service was a family run business and the management team were committed to providing a good quality, effective service to people. The provider said, “We are supporting vulnerable people, we need to get it right for them.” They did this by supporting staff well to promote a consistent staff team, listening to people’s views and looking at ways to continually improve. One person said, “They [the staff] are always lovely. They are reliable and courteous and very helpful. If they are late they ring me and apologise. I’ve never had to complain.” One relative told us, “It’s a gold star agency. [Carer’s name] especially is a superstar.”
People told us they appreciated the visits from staff who were always cheerful and treated them with respect. One person said, “Some [care workers] are wonderful, so nice and I have one care worker who is so helpful. They turned up with a bookshelf for me when I said I needed one. They are like family now.”
Care workers said they enjoyed working for the service. They were well motivated and committed to providing a service that was personalised to each individual. People were fully involved in planning their care and support and care plans were comprehensive to make sure staff had all the information required to support the person. This helped to make sure people received the support they wanted.
There were quality assurance systems which monitored standards and ensured any shortfalls were addressed. People and care professionals felt listened to and said they could speak with a member of the management team at any time. Any complaints, including smaller comments and ‘grumbles’ made were fully investigated formally and treated as learning to enable the service to improve.
People received effective, safe care which met their individual needs and preferences. People told us the service was flexible and made adjustments to accommodate their wishes and changing needs. For example, when people had health appointments or where two people had specific needs there was a contracted agreement that they had access to an on call number at any time which would ensure a visit to provide personal care. Where any concerns were raised about a person’s health or well-being prompt action was taken to make sure they received the support and treatment needed.
People were complimentary about the care workers who supported them. People told us staff were kind, caring and respected their privacy and dignity. There were sufficient numbers of staff employed to ensure people received their care and support at times of their choosing. The service were revising their care worker ‘runs’ to reduce the number of care workers that people received support from. They had recognised that some people, although receiving care from a regular group of care workers, sometimes had seven care workers in a week. However, people told us they knew who was coming to support them in advance and were happy with the care provided.
Most people had a small team of care professionals who they were able to build trusting relationships with. The rota manager tried to match care workers to people using the service to promote good relationships. People said, “They are very kind, they [care workers] can’t do enough for me”, “They are extremely nice to me, they [care workers] always ask if I need anything else doing” and “Yes they support me in a caring and supportive way, they keep me going.”
Care workers were well trained and competent in their roles. Staff undertook training in health and safety subjects and received the training and information they needed to meet people’s specific needs. Training needs were linked to regular care worker competency ‘spot checks’ and supervisions. People told us they felt safe and comfortable with the care workers who supported them and able to discuss any concerns with the office staff. One person said, “They [care workers] do make sure I am safe when moving around, as I can’t see very well.”
Where people received support with medication this was well managed and monitored. Staff had been trained in managing medication and records were completed. Care plans showed how staff were to support people in detail.
People described the service as reliable, telling us that care workers arrived on time and stayed for the allocated amount of time. The office computer system alerted office staff to any late calls as care workers were required to log in on visit arrival and departure. People told us there had never been a missed call and care workers who came were as stated on their rotas.
There was a robust recruitment process to ensure people were protected and cared for by suitable staff. Safeguarding training was completed and staff knew how to recognise and report and action any safeguarding issues to protect people.