Horizon Care (South West) Ltd

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment, we rated this key question Inadequate. At this assessment, the rating has changed to Requires Improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance and notifications.

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.

Despite some improvements the provider still did not have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not fully understand the challenges and the needs of people and their communities.

The provider did not consistently demonstrate a positive, compassionate, listening culture that promoted trust and understanding between them and the people using the service. The provider and registered manager expressed a commitment to improving their culture, but we found evidence the leadership team did not always consider people in a dignified way. This was not in line with the providers Statement of Purpose.

New systems in place to monitor the quality and safety of care were not fully effective. This meant the provider did not have a full understanding of the issues impacting on people using the service, placing them at risk of poor care.
 

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

The provider and management team were not always able to demonstrate they possessed the necessary skills and knowledge to effectively lead and oversee the service. Despite being signposted on several occasions to best practice guidance on care delivery and regulatory requirements, they did not demonstrate sufficient understanding. This limited their ability to apply this knowledge in practice and impacted the effectiveness of their leadership.

This shortfall had also been identified through the provider’s improvement work with the local authority. As a result, the service improvement plan included an action for the management team to complete the training required to strengthen their knowledge, leadership and oversight.

While the management team maintained regular communication with staff supporting people in the community, they did not always ensure risks were effectively managed, that people’s rights were consistently upheld, or concerns were always appropriately investigated. Staff were still not receiving regular one to one supervision and support.

People felt more confident to speak up and that their voice would be heard, however improvements were needed.

The service was starting to address some elements of a closed culture and was more receptive to working with external improvement agencies to develop and implement improvements within the service.

Since our last assessment anonymous satisfaction surveys had been sent out to try and gather the views of people and staff. However, many people told us they had not seen a survey which suggests this was inconsistent.

The service had a whistleblowing policy in place. The majority of staff told us they would feel confident to raise any concerns with the management team.

Theprovidervalued diversity in their workforce. They were in the process of workingtowards an inclusive and fair culture by improving equality and equity for people who workedfor them. These changes were not yet embedded.

Since coming into post the registered manager had taken steps to improve support for care staff and to foster a more equal and inclusive culture. However, there were still areas where further improvements were needed, for example face to face supervision had not yet been initiated.

Staff feedback about the changes was positive. One staff member told us, “The office is a nicer environment to walk in to now as [registered manager] is a good influence, welcoming and supportive. I really do believe that she is doing a good job and has good intentions and is trying her best to make change.”

Staff meetings had been held to ensure all staff had a clear understanding of ongoing developments within the service. Discussions covered changes in management, operating systems and expectations relating to care visits, communication, recording and training. Staff were given the opportunity to ask questions and were told they were valued and appreciated.

Many staff expressed positive views about their working conditions, including the introduction of paid travel time between visits. However, some care staff reported the allocated 5 minutes of travel time was not always sufficient, particularly when travelling longer distances or during periods of heavy traffic.

Staff also highlighted the provider’s flexibility in accommodating working hours around childcare and other personal commitments. Where required, reasonable adjustments were in place to support individual staff needs.

The provider still did not have clear responsibilities, roles, systems of accountability and effective governance systems in place. They did not consistently act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. However, whilst we observed a clear intention to improve governance systems, these remained at an early stage and were not yet fully tested and embedded.

The registered manager had begun to establish a programme of audits to strengthen oversight of the service. However, governance processes were not yet effective in ensuring people’s safety, protecting their rights, or ensuring staff had the necessary skills and competencies to meet people’s needs. As a result, these systems were not driving improvement and failed to identify concerns highlighted during this assessment. They could not be relied upon to effectively monitor quality or manage risk.

Issues were identified across multiple areas of the service including safeguarding, supervision, recording, Mental Capacity Act (MCA), care planning, risk management and the management of people’s medicines. These findings demonstrate that the provider’s governance and oversight systems remained underdeveloped and were ineffective.

The provider had failed to notify CQC consistently of significant changes, events and incidents affecting the service and the people who used it. This is a legal requirement under the Health and Social Care Act 2008. Failure to submit statutory notifications compromises transparency, regulatory oversight, and the ability to safeguard people effectively.

The provider had implemented a business continuity plan; since our last assessment.

The provider understood their duty to collaborate and work in in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

There was a positive shift in the leadership team and their approach to working with other agencies. They had been working closely with the local authority to improve quality, safety and consistency for people using the service. Due to the size of the service, it was recognised this would take some time and the provider had a realistic approach to making sure they maintained good relationships for the good of the staff, people using the service, and improvement.

The registered manager was keen to listen to feedback and work with CQC on sharing information and learning.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

Following the previous assessment the provider recognised that the service required a comprehensive review and significant redevelopment. They told us, “We accepted we got it wrong and we need to put it right. The poor inspection was a catalyst for that to happen.”

Since the last assessment, the provider had been working closely with the local authority quality assurance and improvement team who supported them with appropriate tools and guidance. The primary focus was developing a safe and effective service.

A formal service improvement plan was in place which identified areas requiring improvement, with the necessary actions, clear responsibilities and timescales.

The provider acknowledged that rebuilding the fundamental aspects of the service was the current priority. As such, any ambitions relating to innovation, research, or contributing to best practice were temporarily set aside until a stable and compliant foundation was established.