Horizon Care (South West) Ltd

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment, we rated this key question Good. At this assessment, the rating has changed to Inadequate. This meant services were not planned or delivered in ways that met people’s needs.

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

This service scored 25 (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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People were not routinely involved in the development and review of their care plans. As a result, care plans lacked important details about people’s preferences, likes, and dislikes. We found for some support needs, care plans did not exist or needed more detail. For example, people living with specific health conditions had care plans that did not adequately explain how these conditions affected their daily lives or what staff should do to support them effectively.

People told us the service was not always responsive when they raised concerns about their care. A relative had raised a concern about staff coming late when they were supposed to get their family member out of bed, dressed and make the breakfast. They told us, “I end up doing the breakfast before they get there; I’ve asked them to get here earlier so that they can do all of that, but often the office says they can't do this, or they can't do that, they’re hopeless, very disorganised, not helpful at all”. Office staff had told another person, who had raised a concern about early calls, that they had a routine for their staff and they had to stick to it.

There were significant shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity.

Most people told us they did not consistently receive the care and support that had been commissioned. Care visits were often not carried out at the agreed times, and care staff did not always stay for the full duration of the visit. This was confirmed by staff who told us, “Travel time between visits is not included within my working day. If a service user has a 30 minute visit, I will leave before the 30 minutes if their needs are met as this is used as travel time. This means that carers are always running late if a service user needs their full visit as I am travelling to the next service user during their allotted support time. If it extends my working day, I don’t get paid for that.”

People did not always receive continuity of care with the same staff. Several people said they saw many different care staff which made it difficult to build relationships or maintain continuity of care. Relatives expressed frustration that frequent changes in staff meant new care staff were often unfamiliar with their family member’s routines and needs. Some said they had to give instructions or leave written lists for staff to ensure care was delivered properly. A relative commented, “Nobody tells the new girls anything. They do some basic training and some shadowing but then they are just expected to get on with things and they don't tell them a lot and they're always adding new people onto their rotas.”

There were noticeable differences in the skills, initiative, and approach of staff. While some care staff were described as proactive and attentive, others were perceived as doing only the minimum required, which impacted the overall quality and reliability of care.
 

The provider did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The service failed to meet the requirements of the Accessible Information Standard, which includes identifying, recording, flagging, sharing, and meeting the communication needs of people with disabilities or sensory impairments.

People’s communication needs were not always clearly documented in their care plans, and where guidance was provided, it was not consistently followed by staff. For example, one person with profound hearing loss had requested staff remove their masks and avoid chewing gum or sweets during visits to enable lip reading. Although this request was recorded in their care plan, it was not always followed by staff. When this concern was raised with the provider, it was dismissed rather than acknowledged or addressed.

We reviewed the service user information pack available in people’s homes and found the print to be small and faded, making it difficult for individuals with visual impairments to read. The provider’s contact information was out of date. Additionally, the provider communicated rota and staffing updates via email and text message, which was inaccessible to people without access to a computer or mobile phone.

These issues meant people’s communication needs were not understood or met, potentially impacting their ability to understand and engage with their care.

The provider did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not involve people in decisions about their care or tell them what had changed as a result.

Most people we spoke with said they had not been asked for feedback or had a formal review of their care. One relative noted they had recently received a satisfaction survey for the first time, and another said no one from the office had visited for months to check on care or collect paper records completed by care staff. Some people told us they had not raised concerns with the service as they were not confident their views would be respected, taken seriously, and treated compassionately, without negative repercussions.

The service had a complaints process. However, some people told us when they made complaints or raised concerns, they were not listened to, and action was not taken to resolve issues. Comments included, “They seem to brush things off” and “I’ve had no formal response from them. I’m not at all happy with the administrative side of the company, they don't appear to be at all flexible and I find this very frustrating”.

Some people told us they had no complaints and felt able to speak with staff if they had any concerns.
 

The provider did not make sure people could access the care, support and treatment they needed when they needed it.

The provider did not always consider the needs of people with protected characteristics, for example hearing loss, to ensure they could fully engage with and understand their care.

People did not consistently receive their agreed care at the time they needed it. People told us visits were not always carried out in a timely manner when support was needed, and there could be delays.

The provider did not have effective oversight to ensure people’s care was delivered as agreed. The Directors told us the systems for monitoring visits were working well, but they had not identified the issues we found during our analysis of call data over a 4 week period. For example, 5.8% of calls had not been logged by care staff, so it was not possible to verify that the visit had taken place.

There were on-call arrangements for outside of office hours, but these were not fully effective. A member of staff told us, “I feel very supported during the week. Weekends can be an issue as there is only an emergency line at the weekends. Sometimes I need support at the weekend that does not classify as an 'emergency' but I am not allowed to call. Sometimes I just need clarity on a care plan or reassurance. This leaves me stuck at the weekend and I have to make my own best judgement.”

Staff and leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.

The care records reviewed contained limited information about people’s equality and diversity needs. While religion was noted, there was no detail on how people were supported in relation to their cultural or religious beliefs. Additionally, there was minimal documentation regarding other protected characteristics, such as disability, sexual orientation, or gender identity, and no indication of the support provided to prevent discrimination or uphold human rights. Equality and diversity training was not included in the provider’s mandatory training programme, which may contribute to gaps in inclusive and person-centred care practices.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. This is important because it provides staff and provider clarity on people’s wishes including choices about their care, treatment and support so these can be attended and respected.

Care plans did not contain evidence of future planning to support people with major life changes, including when they were coming to the end of their life. Care records did not always contain information around people’s resuscitation status. This put people at risk of not receiving person centred care or experiencing positive outcomes if their health deteriorated.