New Horizon Care

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe. There was an increased risk that people could be harmed.

This service scored 59 (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 worked to develop a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Incidents were recorded with detail of any actions taken as a result. When any incidents were recorded, managers received an alert, so they were immediately aware. The registered manager reviewed these records regularly so they would be aware of any emerging patterns and trends. However, this did not always result in timely action being taken or reflective practice to ensure lessons were consistently learnt. For example, we found an increase in incidents wherea person became distressed and staff had used regular doses of a medication that was prescribed as and when required. Although there was an awareness of a change in the person’s needs, there was a lack of effective analysis of incidents to review potential contributory factors, including staff approaches and responses. The registered manager acted on this concern following our inspection visit. We received mixed feedback from staff, with some staff saying they could raise concerns, and these were acted on and others stating they felt they had to keep raising concerns about incidents before action was taken and improvements made, though these staff did feel improvements were slowly being introduced to address this.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. The provider had procedures in place to ensure people’s transition to and from other services was well-managed, including by involving people, their families, and relevant healthcare professionals. The clinical lead ensured staff were suitably trained and assessed as competent to ensure smooth transitions where people required support to manage complex health conditions and associated equipment.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. People and their relatives told us people felt safe with staff. People told us, “I do feel safe. the staff are very nice, and I feel confident in their care, and I know the staff; there are no strangers” and “The care is good, so I feel safe. Staff arrive on time; it is the same care team; I know them all.” A relative told us, “[Name] wouldn’t be with them if I didn’t think they were safe. They have to manage a lot of things. If things don’t go quite right, I take it up with them and they have always upped their game.” Staff demonstrated they understood their role and responsibilities in protecting people from harm. A staff member told us, “I make sure people are out of danger. If there is abuse around them; make sure you report it.” Records showed staff had reported concerns to the local authority safeguarding team, who were responsible for investigation concerns of abuse. Staff had completed training in safeguarding, and their understanding was regularly assessed. People’s care plans included any community orders to help ensure any restrictions were lawful and in the person’s best interests.

The provider worked with people to understand and manage risks by thinking holistically. Overall, people told us they felt staff managed risks well. One person told us, “The staff use a hoist. They use it correctly and they are safety conscious.” Some relatives felt staff were not always confident in managing risks associated with people’s care. A relative told us, “There is a hoist for the chair and a ceiling hoist. There was a report from an OT saying they weren’t using it properly. I don’t know if they got more training after that. That was last year. The OT came out a few weeks ago but just took their word for it that they could use it. Agency staff don’t know how to use equipment. I don’t know if that has happened recently.” A staff member described how they managed risks, “If there’s any risk or any hazards that we notice, we immediately inform the office, remove ourselves if needed and ask for help. Normally we deal with these things with the office.” We found risk assessments around supporting people to change position, or transfer, required further development to specify equipment assessed as safe to use for each person. The provider had a process they followed after any accident or incident which involved staff completing incident forms and subsequent analysis. We found this process was not always effective in identifying risk and ensuring timely action was taken. For example, we found staff reports relating to a person’s distress did not support effective oversight. Their positive behaviour support strategy did not inform staff of safe physical interventions where the person or others were at risk of harm. There was a lack of explanation around the frequent, daily use of medicines for reducing anxiety that were prescribed as and when required. There was a potential risk that the person was being unlawfully restricted. Further review of these incidents with the registered manager and clinical lead showed some action had been taken through changes in staffing and requests for review of medicines and interventions. The registered manager updated the positive behaviour support strategy following our inspection visit to ensure staff were provided with clear guidance around authorised interventions and a clear audit trail through more robust record keeping. People told us and records confirmed robust risk reduction measures were in place to support staff to undertake delegated healthcare tasks (clinical tasks delegated to care staff) under the supervision of the clinical lead. For example, people were supported to manage peg feeds (feeds administered through a tube directly into the stomach) safely which mitigated the risk of people requiring hospital admissions and improved their quality of life.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People’s care plans included information for staff regarding potential environmental risks, such as location of emergency utilities and any known risks, including pets and access to people’s homes.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. People told us, “I don’t feel rushed at all. The staff can arrive about 10 minutes late, but I know they are going from client to client. The staff stay as long as they should. They come in here and do what they need to do and go. The carers are usually female, which is what I asked for. They come here four times a day and there are two staff” and “The staff have the right skills to help me.” Some relatives felt there was variance in staff approaches and skill set. For example, they told us some staff were not good at general communication but appeared more task focussed. Some relatives were concerned staff were not always familiar with people’s preferred cultural choices, particularly around food. We raised this with the registered manager who told us they would provide extra support for staff to understand people’s cultures. Staff provided mixed feedback around staff cover and managerial support. A staff member told us, “I have in the past under previous management witnessed unsafe staff practices and had to raise concerns constantly to get action taken. The current management seem to take safety more seriously and improvements are being made slowly. We are now getting supervision and spot checks on staff practices, but this is recent and rarely happened before the current management.” A second staff member told us, “Staffing is an issue as [management] keep sending staff that [Name] doesn’t know which causes them to be distressed.” Staff received core training before working independently and specialist training including learning disabilities and delegated healthcare tasks, with competencies assessed by the clinical lead. A staff member told us, “The management check e-learning completion regularly and make sure we complete this. Some tasks are clinical and we have face to face training and the trainer follows you on visits and checks your competency. That is how I was trained in PEG feeding.” A second staff member told us, “The training is quite brilliant. I am always reminded about training via emails and if I need refreshers. We do physical clinical training and some online refresher courses. Supervision is about every 4-6 weeks and we also have spot checks which are unannounced.” Staff were recruited safely. We saw documents to confirm that DBS checks were part of the recruitment process along with the necessary references and right to work checks.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Most people felt staff were skilled at protecting them from the risk of infections. People’s comments included, “Oh yes, staff are respectful of my home and my personal items. The staff wear gloves and masks” and “Staff always wear gloves when they need to. If anyone has a cold they wear a mask.” However, some staff required further support and training to ensure they followed safe processes in their working practices. A relative told us, “Staff help [Name] to use the commode and urine bottles. When they come in, they put gloves on and empty the urine bottles but then prepare [Name’s] food and don’t change the gloves.” We raised this with the registered manager who told us they would address these concerns with relevant staff. Some relative felt staff needed further training in food hygiene. They told us, “I am not sure about the food hygiene as we have found things very out of date.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. Staff were trained in medicines administration, and the registered manager checked their competency. The registered manager had completed medication audits to ensure medication administration records (MARs) were accurate and medicines were given on time. However, we found records required further development to provide staff were sufficient information around include reason for prescription, duration, maximum dose. People told us, “Staff give my medication on time; they are very punctual” and “I have my tablet each day given in the correct way.” Any errors were reported and acted on, though we found one instance where staff had not sought clinical advice to assess for any adverse effects from a medicine error. A relative told us, “There have been a couple of incidents. [Name’s] nighttime tablets weren’t given. There was another confusion about only part of their tablets being given. I spoke with the nurse who clarified that all the tablets should be given and they were going to make it clearer. All tablets have now been given and there was no impact to [Name] from this.