Horizon Care (South West) Ltd

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• 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 Inadequate. At this assessment, the rating has changed to Requires Improvement. This meant people’s needs were not always met.

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

This service scored 43 (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 make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

At the time of our previous assessment the service did not routinely complete risk assessments and care plans with people.. Community managers were now in the process of completing risk assessments and care plans face to face with all of the people supported by the service. This was a substantial piece of work which prioritised the people at the highest level of risk. The majority of care plans for people at medium and low levels of risk were still to be completed. This meant that for these people their care plans were not person centred and lacked important details about their care needs, preferences, likes and dislikes.

Newly completed care plans contained more detailed information about how people wished to be supported. One person told us, “The care plan is really very thorough and we were fully involved.” We observed care staff supporting people in line with their documented wishes, for example in relation to support with personal care and food choice.

People confirmed staff understood their needs and preferences, telling us, “They know exactly how I like things done without me having to say” and “They follow my routine properly.”
 

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

Since coming into post, the registered manager had introduced more effective systems for staff to sign in and out of care visits and strengthened oversight of this process. Data analysis showed some improvement in visit timings and duration, with more people receiving the support that had been commissioned. However, there remained a number of short calls where less than half of the planned time was delivered. In addition, several people told us that visits did not always take place at the agreed times, which had a negative impact on their care. For example, one person living with diabetes reported being unable to eat until care staff arrived to support them into a chair. Another person told us, “The carers are often late, don’t let me know and sometimes only stay 10–15 minutes. The service is not very good for what we pay for it.”

We received some positive feedback regarding continuity of care, with people valuing the relationships they had built with regular care staff. Others reported being supported by a number of different carers; however, these staff were generally described as reliable and having a good understanding of their needs.

There was some inconsistency in whether people received a rota in advance, although overall feedback indicated there had been improvements in the staff rota system since the previous assessment. One person commented, “They are better organised these days than they were. The rota system has improved. It’s sent weekly on my phone.”

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

The new care plan format included a communication section designed to document any difficulties with speech, hearing, sight, or written communication. They also advised of the person’s preferred communication method, i.e. telephone, face to face or letter. However, a review of care plans identified gaps in how these needs were addressed and how people could be supported to access written information, for example rotas, care plans or satisfaction surveys. One individual, registered as partially sighted and experiencing difficulty with written communication, had no guidance in their care plan on how information should be adapted to meet their needs. Similarly, another person who lived alone was noted as requiring assistance with written communication, but the care plan did not specify the type of support required or how information should be provided.

These omissions indicate that people’s communication needs were not fully understood or consistently met, which may impact their ability to understand and engage with their care.

The registered manager recognised the need to improve communication practices. They explained their intention to identify individuals who may struggle to access information such as rotas. While most people had a family member who could receive this information on their behalf, alternatives such as providing rotas in large print were available upon request.

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

Following the previous assessment the registered manager had taken steps to increase opportunities for people to provide feedback about their care. However, these improvements were still in the process of being embedded.

Satisfaction surveys had been carried out to gather the views of people using the service, and feedback had been analysed to identify themes and trends. However, several people told us they had not been asked to complete a survey, suggesting the process had not been implemented consistently.

The service had a complaints policy and process in place, and people told us they would feel confident contacting the office if they wanted to make a complaint. However, a review of complaints received since the previous assessment found they had not always been fully investigated or managed in line with the providers complaints policy.

Care plans were in the process of being reviewed with people, providing an opportunity for them to express their views and be involved in decisions about their care. However, the majority of these reviews had yet to be completed.

The provider did not always make sure that 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 sensory loss, to ensure they could fully engage with and understand their care.

Since coming into post the registered manager had improved oversight of visit timings to monitor whether care was delivered as commissioned and whether care staff stayed for the required duration. While these actions had led to some improvements, people did not consistently receive their care at the time they needed it. This had a negative impact on their wellbeing, including risks associated with diabetes management, or not receiving medicines at the time prescribed.

There were on-call arrangements in place outside of office hours, and staff reported they felt well supported by the management team.

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.

Care plans were in the process of being reviewed with people however, the new format often contained limited information about their equality and diversity needs. Sections relating to religion and sexual orientation were frequently left blank or recorded as ‘not known’. There was minimal detail outlining how people were supported in relation to their cultural or religious beliefs or other protected characteristics, such as disability, sexual orientation, or gender identity. In addition, care plans did not clearly demonstrate how support was provided to prevent discrimination or uphold people’s human rights.

Following the previous assessment Equality and Diversity training had been introduced as part of the provider’s mandatory training programme.

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 to and respected.

We reviewed people’s care plans, however none contained evidence of future planning to support people with major life changes, including when they were coming to the end of their life. This put people at risk of not receiving person centred care or experiencing positive outcomes if their health deteriorated.

Care records did however contain information around people’s resuscitation status and where this information was kept.