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Inspection Summary


Overall summary & rating

Requires improvement

Updated 30 April 2019

We undertook an unannounced focused inspection of Horizon Close on 7 November 2018. After the comprehensive inspection dated 10 October 2018 we received concerns in relation to staff not having appropriate checks before starting employment, language barriers of staff, poor working and living conditions for staff working as agency staff, competency of staff undertaking maintenance checks and lack of equipment across the Glenside Manor site. As a result, we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to these concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link Horizon Close on our website at www.cqc.org.uk.

The team inspected the service against one of the five questions we ask about services: is the service well led. This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvement were identified in the remaining Safe, Effective, Caring and Responsive through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

The aim of Horizon Close is to provide maintenance and rehabilitation programmes for adults with long-term neurological conditions. Accommodation is organised into ten bungalows and is one of six adult social care locations which also has a hospital that is registered separately with CQC. Glenside Manor Healthcare Services is not close to facilities and people may find community links difficult to maintain

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

A registered manager was in post. 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.

At the previous inspection dated 10 October 2018 we found a breach of Regulations 9, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider following the inspection to tell us how they were going to meet the legal requirements of these regulations. . Following the inspection, the provider failed to report within the timescale specified the intended actions to meet breaches of Regulations. At this inspection we found continued breach of Regulation 17.

following the inspection we formally requested under Section 64 of the Health and Social Care Act 2008 to be provided with specified information and documentation by 16 November 2018. We received some of the information requested but not all.

Quality assurance systems were inadequate. Audits were not robust and did not provide an accurate assessment of the quality of care delivered. Action plans were not developed to drive improvements.

Recruitment procedures did not ensure the staff employed at the home were suitable to work with adults at risk. We received whistleblowing concerns about staff not able to speak sufficient English and that agency staff were working without appropriate checks. We found there were some staff working across the site without the appropriate disclosure and barring checks or references in place. Relatives also expressed concerns about staff who were not able to speak or understand English.

Staff morale was poor and staff told us they feared about their jobs as they had witnessed other staff being dismissed almost daily. The staff survey indicated that 13 of the 38 staff responding would recommend the home. There were agency staff working as well

Inspection report


Inspection areas

Safe

Requires improvement

Updated 22 December 2018

The service was not safe.

Staff were knowledgeable about people’s individual risks and the action needed to minimise the risk. Risk assessments were not in place for people that self-administered their medicines.

Staff knew the procedures for safeguarding people from abuse. People felt safe at the home.

There were sufficient staff on duty to provide people’s basic needs.

Effective

Requires improvement

Updated 22 December 2018

The service was not effective.

The needs of people were not fully assessed as they moved between services. Discharge care plans were not in place for people moving out to live independently.

Staff had suitable skills and received training to ensure they could meet the needs of the people they cared for.

People’s health needs were assessed and were supported by the GP to stay healthy.

Staff were knowledgeable about people’s abilities to consent to their care and treatment and they were supported to make decisions.

Caring

Good

Updated 22 December 2018

The service was caring.

People told us that staff were kind and caring. The staff spoke about people in a caring and respectful manner.

People told us the staff respected their rights. Members of staff were knowledgeable about building relationships with people and why this was important.

Responsive

Requires improvement

Updated 22 December 2018

The service was not responsive.

Care plans were not always person centred and did not reflect people’s current needs. Care plans were not devised on how to support people with independent living skills.

There was a programme of activities within the Glenside Hospital site which people could join.

Complaints were recorded and investigated.

Well-led

Inadequate

Updated 30 April 2019

The service was not well led

The quality assurance systems in place were inadequate. Audits were not robust and did not assess all areas of service delivery. Action plans were not developed on driving improvements.

CQC were not notified about incident and accidents or of events reportable by legislation.

Inspection report