Horizon Care (South West) Ltd

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

The service was in breach of legal regulation in relation to people’s safe care and treatment, person centred care, dignity and respect, and staffing.

This service scored 45 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity. Staff did not always treat colleagues from other organisations with kindness and respect.

We received mixed feedback about the kindness of care staff. Some people reported a lack of compassion, saying staff were rushed, did not engage, and sometimes failed to introduce themselves. One person said, “They mostly don't ask how I am… they come in, rush about and are gone.” Another person said, “Some of them don't even speak to you or introduce themselves. They just let themselves in and start with what they need to do.” Other people described staff as kind, respectful and caring, which was also observed during the assessment. Comments included, “They are gentle when they help me,” and “They make [family member] laugh… all the ones she's got are lovely.”

The provider did not always respond with compassion when concerns were raised about people’s care. We received a concern from health professionals about an elderly carer struggling to support their family member. The carer was having to provide care themselves because of late visits and commissioned tasks not being completed by care staff. We raised this with the provider, who dismissed the concern and took no action, saying the carer was abusive and rude to care staff and their family member. One person told us, “The office staff on the phone always seemed to be a bit bad tempered and not very patient. That's also why I'm not very keen to complain in case they stop me from having any care.”

The provider did not always treat colleagues from other organisations with kindness and respect. External professionals described the provider as ‘hostile’ and unwilling to engage.
 

The provider did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, and protected characteristics.

The provider did not always involve people in planning their care. This meant care plans contained minimal information about the person, their wishes and preferences and did not support staff to provide person-centred care. One staff member told us, “I get a task list within the app to complete on each visit- these are not detailed descriptions of how that person wants to be supported but I know that everybody is different.”

Communication needs were not consistently met, which limited people’s ability to engage in their care and support. For example, one person who was profoundly deaf reported difficulty lip-reading particular staff members due to their strong accent. They requested to be supported by care staff with whom they could communicate more effectively. However, this request was refused and interpreted as the person being difficult. This response demonstrated a lack of consideration for the person’s communication needs and preferences, and raised concerns about the provider’s approach to person-centred care and equality.

We also found examples of good practice that demonstrated a commitment to person-centred care and inclusive communication. One staff member described how a person who did not speak English was supported by a colleague who shared the same language. They told us, “The member of staff helped the rest of the team to learn key phrases and words to aid communication. This had a really positive impact on the client.” Other staff members demonstrated a proactive approach to understanding and respecting individual preferences. One said, “I check with the service user how they like these needs upheld and look at the care plan. I know that preferences change day to day, so I always have to check with the person and the care plan.”
 

The provider did not promote people’s independence, so people did not know their rights and have choice and control over their own care, treatment and wellbeing.

People were not consistently involved in planning or reviewing their care, and opportunities to provide feedback about the service were limited. As a result, people did not always have full control or choice over their care and how it was delivered. A relative commented, “I think we did discuss what help [family member] needed but it was all very rushed when they came out of hospital and I’m not sure what is exactly on their list.” Some said the service checked on them periodically, or that community managers occasionally asked whether everything was satisfactory. However, these checks were generally described as rare and not part of a structured review process.

People had little control over when their visits were scheduled or delivered, or which care staff would be supporting them. Where people had asked not to have certain staff members this had not always been respected. They had not always been asked whether they would prefer a male or female member of care staff.
People’s experiences of staff consistency and punctuality varied. Some people we spoke with said they had a regular team of care staff who arrived on time and stayed for the full visit. The majority however reported frequent changes of staff, fluctuating visit times and poor communication from the office. Several people said they saw a large number of different care staff, sometimes as many as 15 to 20, which made it difficult to build relationships or maintain continuity of care. Even when rotas were provided, visit times were frequently altered, often without notice. This inconsistency left people unsure who to expect or when staff would arrive. One person described feeling anxious when care staff were late and worried they might not come at all. Another relative said when staff came too early and were turned away, the visit was sometimes missed altogether.

Although staff spoken with demonstrated an understanding of the importance of giving people choice and obtaining consent, they demonstrated limited awareness of how to uphold people’s human rights under the Mental Capacity Act 2005. This raised concerns about how well the service supported individuals to make informed decisions about their care.

The provider did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Our analysis of visit records over a 4 week period found that 31% of calls were completed in less than half the planned duration. This significantly impacted the ability of care staff to deliver safe and effective care, limiting the time available to meet people’s needs or respond to changes in their condition. For example, one complaint form detailed concerns from a relative who reported care staff were only staying for 10 minutes. This was not long enough to meet their family member’s needs and was putting them at risk.

We heard from a relative whose family member had medical appointments and was transported by ambulance. Despite providing advance notice and leaving reminders for staff, care workers did not arrive early enough to support the person in getting ready. The relative told us, “It is hard to understand because I also leave a note out for them too in the kitchen just to remind them that they need to be early for her appointment. I do tend to give them a couple of weeks’ notice, but I suppose it may be hard for them to change the rota.”

Despite these concerns, we also received some positive feedback about the responsiveness of individual staff members. One relative said, “They do phone me if they're worried about anything, and they also phone the office to let them know, for example, if [family member] seems a little under the weather.” People were also positive about the community manager, who was described as approachable and responsive. One person told us, “Yes, I did feel that she listened to what I had to say, and I feel that they would try to sort out any problems.”

The provider did not always demonstrate they cared about and promoted the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Prior to, and during our assessment we received anonymous concerns about how staff were treated by the provider, including fears of being targeted if they spoke up. Some staff we spoke with expressed concern about the lack of travel time between visits and the pressure this placed them under, long working hours, and a lack of understanding and support in relation to personal difficulties.

People using the service expressed concern for the wellbeing of care staff. Comments included, “A lot of (staff) are worked to the bone, they're working from 6:30 am to 11 pm; some of them seem half asleep” and, “I'm not sure how well supported the carers are by the management. I think they feel overwhelmed with work, and they are so busy. I know that some are even diabetic, and I've had one come in and asked if she could eat something as her sugar level had gone down to 2… I feel so sorry for them.” Another person raised concerns about the safety of care staff who, without access to transport, were walking to visits late at night.

Despite these concerns, we received some positive feedback from many of the staff we spoke to. They told us they were well supported, and the management team were approachable.