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Inspection carried out on 7 November 2018

During an inspection to make sure that the improvements required had been made

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 carried out on 10 October 2018

During a routine inspection

This inspection took place on 10 October 2018 and was unannounced. Horizon Close is one of seven adult social care locations situated on one site, known as Glenside. The site also contains a hospital, which is registered with us separately. Glenside is not close to facilities and because of the location it will be difficult for people to have a presence in the local community. Horizon Close supports up to 10 people over the age of 18 years, in single occupancy, simulated supported living bungalows.

At the time of the inspection, there were five people using the service. It is a ‘care home’. 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.

At the inspection dated June 2017 we rated this service as Requires Improvement with a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We received an action plan from the provider telling us how the regulation was to be met following the inspection. At this inspection we found this action was completed.

This is the second consecutive time the service has been rated Requires Improvement.

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.

The staff at the home were not aware who the registered manager was, they had assumed the unit manager had this role. The unit manager said they had day to day management responsibility for this service including staffing. The staff said the team worked well together and the unit manager was approachable.

People we asked were unsure if they had a care plan in place. While the unit manager told us people’s needs were assessed before their admission, copies of assessments were not in place. For one person the staff had reviewed the care plans from the previous placement as current to Horizon.

There were aspects of person centred care plans but care plans were not in place on how people were to be supported with their discharge or developing the skills to live independently. People told us discharges were not well planned.

People had access to a GP and on-site health care services. There were concerns whether people were having satisfactory physiotherapy. People told us they were promised daily allied healthcare support such as occupational and physiotherapists. They said the therapists support was to help improve their abilities with functioning. People raised concerns about the lack of allied healthcare staff and that these staff were leaving. People and relatives told us their sessions were often either cancelled or started later than expected.

Quality assurance systems were not effective because audits used to assess the quality of service were not detailed or covered all areas of people’s care delivery. Where shortfalls were identified, action plans were not devised on how to fully meet the outcomes assessed. Some audits had identified the outcomes assessed as complete. This was not reflective of the inspection findings.

The unit manager told us there was continuous learning from reporting processes which gave staff confidence to report accidents and incidents appropriately. There had been a number of events including theft, poor practice from staff and failure of heating systems. However, these had not been reported to CQC. This meant CQC were not able to assess the follow up action to take.

Complaints were not always resolved. People told us they could discuss any issues with the staff. One relative told us therapies promised did not materialise. This relative said they had made numerous comp

Inspection carried out on 15 June 2017

During a routine inspection

We carried out this inspection over two days on 15 and 20 June 2017. The first day of the inspection was unannounced. Horizon Close is one of seven adult social care locations situated on one site, known as Glenside. The site also contains a hospital, which is registered with us separately. Horizon Close supports up to 10 people over the age of 18 years, in single occupancy, simulated supported living bungalows. At the time of the inspection, there were five people using the service.

Horizon Close was registered as an adult social care location in August 2016. Previous to this, the location formed part of the overall site of Glenside. This was the location’s first inspection, as part of the adult social care directorate.

There was a registered manager 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. The registered manager was available throughout our inspection.

There were systems in place to assess, monitor and mitigate risks relating to the health, safety and welfare of people. A traffic light system was used, which identified any shortfall and its level of risk. Records showed further checks were completed to ensure compliance. However, audits had not identified that two staff had not completed fire safety refresher training or that a day and night time fire drill had not been undertaken. This was despite the fire drill being identified as a 'level one' priority. After the inspection, a senior manager told us fire training was monitored on a monthly basis and formed part of the monthly quality report. A fire test was completed on the day of the inspection.

There was a positive approach to risk management. However, not all risks associated with each person’s bungalow had been consistently considered. Staff supported people to think about risk taking and how they should do this safely. There were a range of assessments to identify and assess potential risks. The assessments were clear and up to date. Systems were in place to support people to manage their medicines safely. Each person was on a medicine “pathway”, linked to their ability. As the person’s competence and confidence increased, they moved further along the pathway until they were fully independent with their medicines.

There was a strong emphasis on rehabilitation to enable people to reach their potential and move to more independent living. Each person had a clear support plan which they were fully involved in developing. The information detailed individual goals and regular assessments were undertaken to monitor progress. In addition to receiving support from the rehabilitation staff, people were well supported by specialist services. This included an on-site team of professionals such as psychologists, occupational therapists and physiotherapists. All sessions were built into each person’s weekly plan and there were weekly multi-disciplinary meetings to discuss progress.

People were supported with meal arrangements if needed. This included support with tasks such as making a shopping list, purchasing food and cooking the meal. People were encouraged to be as independent as possible. Some people did not require any support in this area. Other areas of support included budgeting, housekeeping, accessing community services safely and using public transport.

There was an open approach to complaints and clear processes were in place. Records showed any complaints were properly investigated and a satisfactory outcome was reached. People knew how to make a complaint and were encouraged to give their views about the service. They did this by attending regular meetings and completing satisfaction surveys. Action had been taken in response to people’s requests