The Care Quality Commission
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  • Homecare service

Archived: Horizon Care Agency

Overall: Good read more about inspection ratings

Regus House, 1 Emperor Way, Exeter Business Park, Exeter, Devon, EX1 3QS (01392) 426340

Provided and run by:
Horizon Care (South West) Ltd

Important: This service is now registered at a different address - see new profile
Important: This service was previously registered at a different address - see old profile

All Inspections

5 and 7 January 2015

During a routine inspection

We undertook an announced inspection of Horizon Care Agency on 5 and 7 January 2014. We told the provider two days before our visit that we would be coming. Horizon Care Agency provides personal care services to people in their own homes and occasionally provides care workers to other services registered with CQC. Horizon Care Agency is a large domiciliary care agency and at the time of our inspection over 220 people were receiving a personal care service. The agency employed approximately 86 care workers as well as care managers and administration staff.

At our last inspection in June 2014 the service was not meeting all the regulations inspected. The service was non compliant with outcomes 9 Medication and 21 Records. We received an action plan detailing how the agency were addressing the issues and during this inspection we found the issues had been addressed as described. Medication information was clear in care plans and medication records completed correctly.

The service has a registered manager. 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 and associated Regulations about how the service is run. The registered manager and office staff were accessible and overall people were happy with the service provided. The agency were responsive to people’s changing needs, for example, sending managers to visit people to review care plans, check they were happy with the service and covering staff if there was a delay due to an incident.

Most people praised the service and had no concerns about the standard of care provided by the agency. However, we received a mixed response from people using the service, relatives, social care professionals and staff about the quality of communication and “unprofessional” or “rude” attitude at times when contacting the management/office team. Although most people who used the service, staff and relatives, felt able to speak with the registered manager and office staff and provided feedback on the service, around 11 people and a group of staff as well as four social care professionals commented on attitude. There was also a comment relating to an occasional “blunt and rude” attitude of office staff in the last inspection report.

The service undertook regular spot checks and care reviews to review the quality of the service provided and had good systems to manage recruitment, staff competency and training, sickness levels and staff issues. People were kept safe and free from harm. There were appropriate numbers of staff employed to meet people’s needs and provide a reasonably flexible service. When people’s care initially began it could take a few weeks for care workers to become more regular as space was found within care workers rotas. People were given weekly rotas so they knew which care worker would be visiting.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

Staff knew the people they were supporting and provided a personalised service. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. People told us they liked the staff and felt cared for and treated with dignity and respect. For example, “The girls are lovely just perfect, I’m happy with the care” and “I have no complaints, they are all extremely nice and very caring”. Concerns and complaints were recorded including telephone concerns and these were dealt with well.

People were supported to eat and drink as required by the information in their care plans. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs. Staff had a good understanding of the Mental Capacity Act (2005) and how to manage decision making where people using the service were living with diminished mental capacity.

19, 24 June 2014

During a routine inspection

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

On the two days of our inspection there were approximately 200 people using the service. The summary is based on conversations with 36 people using the service, eight staff supporting them and some family representatives, a health care professional, the registered manager and office staff. We looked at records and visited three people who used the service.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was safe because care workers understood their role and responsibilities and they received close supervision of their work. They received monitoring visits, staff training and meetings. Staff received an induction prior to working with people using the service and ongoing training updates. However, some care workers felt they needed additional training when they had been new to care work when they started with the agency.

The service was safe because staff were trained in how to respond to concerns which might indicate abuse had occurred. The agency responded appropriately to protect those people.

Some people had been put at risk, examples being care workers who were unwell when visiting them and a care worker leaving a vulnerable person for a short period of time with no carer. However, the agency responded robustly to issues which might indicate poor standards of care.

The service was not adequately safe due to changes in people's care needs not being reflected in their care plan, which had not been updated and therefore did not inform care workers what care was agreed and required. We also found medicines were being administered which were not part of the person's care plan. This posed a risk from mistakes and/or mishandling due to the nature of the medicines.

Is the service caring?

The service was caring because people thought highly of the care workers who provided their care. Comments included, "The carers are brilliant and I always have the same ones', "Care, excellent", "The lady is very good indeed" and "They are wonderful. Always cheerful, friendly and they brighten your day up." One person thought their relative was treated as 'an idiot' due to their hearing loss. In contrast the agency had ensured two people with sensory disability had their specific needs addressed.

The serviced was caring because it responded to people's requests where possible. One person told us "A problem I had was dealt with almost immediately". Another said "The office responds to my requests every time". However, by contrast a similar number of people told us the office staff could be 'blunt' and 'rude'.

Is the service effective?

The service was effective because people said their needs were being met. They told us "They certainly provide me with the right care and support" and 'They follow my plan of care and my requests". A health care professional said "I have to liaise with the care workers a lot and they always follow advice".

The agency worked hard to ensure staff understood their role and provided an effective service. To this end they awarded a 'carer of the month' award and wrote to each care worker who received individual praise from a person using the service.

Is the service responsive?

The service was responsive to complaints or issues of concern raised. Examples included some changes to visit times, alleged poor practice, change in needs and where vulnerable adults might be subject to abuse or neglect. We saw records showing agencies, such as the local authority review team and the local authority safeguarding team, were contacted where there were such concerns.

We were given an example of where a care worker found a person had fallen and called an ambulance immediately although their family were present. The family praised them for their swift response.

Is the service well led?

The service was well led. It was evident that the provider expected high standards from staff.

There were arrangements in place to ensure incidents and events were acted on and followed up a robust way. For example, through the computerised recording system which detailed actions taken, what follow up was required and staff disciplinary procedures.

The service was well led because people's views were sought on a regular basis and, where possible requests for changes were made. Examples where this was not always possible were changes in visit times. We were told these requests were not forgotten and were acted on if the opportunity arose later.

27 November and 2 December 2013

During a routine inspection

We carried out this unannounced inspection on 27 November 2013 in the registered office and on 2 December 2013 where we visited three people in their own homes with their permission. We spoke with them and their relatives about their experiences of the support they had received. Comments were all positive. We also spoke with three people over the telephone. We spoke with the registered provider and three staff, including a community manager, in the office and also spoke with three staff chosen at random from the staff list over the telephone. At the time of the inspection the agency was providing care for approximately 200 people and employed around 70 care workers, three community managers and six administration staff. We also spoke with an external health professional who raised no concerns about the service.

We looked at care records kept in the office and also in people's homes. We also looked at key documents including care plans, risk assessments, staff training, supervision and complaints/compliments files as well as policies and procedures.

People told us the support given by the agency met their needs and their dignity was respected whilst staff promoted their independence. We heard examples of how people received personal care in a private and dignified manner. Comments included

''They do very well, I've got no problems. I get the same girl every week which is lovely' and 'On the whole, no I have no problems, the care plan is very explicit about what they need to do'.

Care and support was assessed and planned, with people being involved with deciding how their care should be delivered. Detailed plans were in place to minimise identified risks and ensure that staff had the information to meet people's needs. These included reasons why people needed care at home as well as tasks for staff to carry out at each visit. Staff showed us how they cared for people in an individualised way and identified changes in need in a timely way.

There was good communication and attention to staff welfare as well as a system to monitor the competency and quality of their work. Therefore staff knew what was expected of them although two staff said that they would like more staff team meetings, which the provider had already acknowledged. One staff member said "I have never had so much training as I do here compared to other services.'

The provider had an effective system to regularly assess and monitor the quality of service that people received.

7, 11, 14 February 2013

During a routine inspection

We carried out this unannounced inspection on 7, 11, 14 February 2013. We also spoke to four people using the service and two staff on the telephone on 25 February 2013. During our visit to the agency office we met and spoke with the manager/provider, four members of staff, including the trainer, and two care workers. We visited four people in their own homes and spoke with them and their relatives about their experiences of the support they had received. We looked at key documents including care plans, risk assessments, staff training and recruitment files and quality assurance.

People told us the support given by the agency met their needs and their dignity and independence was respected. We heard examples of how people received personal care in a private and dignified manner. Comments included ''I couldn't ask for better, they always do what you ask.'' Another person said 'They are fantastic, I am perfectly happy with them'.

Care and support was well planned, with people being involved with deciding how their care should be delivered and plans were in place to minimise identified risks. Staff had received relevant training including the protection of vulnerable adults and understood what the processes were for reporting any concerns. This helps to keep people safe. The agency had developed ways of making sure people had their say and were listened to. People told us they had no hesitation ringing the office if they had any concerns or complaints.

11 May 2012

During an inspection looking at part of the service

This inspection took place over four days. On 4 May 2012 we visited the agency office where we looked at the records the agency is required to maintain, including care plans, computer records, weekly timetables, staff recruitment files, management of medicines, complaints and quality assurance systems. We also talked to the management team who were based there.

We visited six people in their homes to find out their views on the services they had received from Horizon Care Agency. We looked at the documents held in their homes that described their care needs and how they wanted to be assisted. We also saw the daily reports completed by care workers after each visit. We also talked to five people who received a service, three relatives and eleven care workers on the telephone. We met one care worker during our visits to people in their homes.

At the time of this inspection the agency provided a care service to approximately 160 people. They employed 50 care workers, including three community managers.

During this inspection we saw evidence to show that the providers had taken a range of actions to improve the service since we visited the agency in July 2011. We also heard about further improvements they plan to make in the future. However, more than half of the people we talked to said they were unhappy about some aspects of the service.

Seven people said they sometimes experienced missed visits, or visits much earlier or later than they had requested. They said sometimes the agency had phoned to tell them the care worker was running late, but they said this did not always happen. One person said they had complained to the agency office and had told them 'Please give me the courtesy of a phone call.'

People told us they did not know who would be visiting the following week, or the day or times of the visit. We talked to the providers about this. They told us they planned to give people timetables on a regular basis in future so that they will know who will be visiting them, and the times of the visits.

Five people said that sometimes care workers did not stay for the full allocated times. They said the care workers complained of being rushed. Nine care workers told us they were unhappy about the lack of travel time allocated between each visit. This meant that they either had to leave each person early, cutting the visit short, or they arrived late at their next visit. We talked to the providers about this. They told us told us they were planning to add some travel time to the timetables in the future to address this problem.

Five people said they were concerned that there had recently been a high turnover of care workers. They were unhappy about the competence of some newly recruited care workers who had visited them. We talked to the provider about this. They told us the agency had expanded in recent months, and therefore they had recruited new staff. They said very few care workers had left the agency in the last six months.

Five people told us they had contacted the agency office to complain about the service but they felt they had not been listened to, and their complaints and concerns had not been taken seriously. When we visited the agency office there was no record of the complaints people had told us about. We talked to the providers about this and they said they will keep a record of all complaints and concerns in future, including calls from people about missed or late visits.

People told us they liked all, or most of the care workers and said were always friendly, kind and respectful. Comments included: 'All the carers are wonderful!' and 'The carers are really nice.' However, we were also given examples of poor care, including care workers not washing or drying a person carefully, resulting in bruising, and care workers unable to put a person's elastic stocking on correctly. People said the care workers had not received training or sufficient information on how to carry out these tasks safely. All of the people we visited had a file containing a copy of their care plan. This ensured that care workers knew what tasks each person needed assistance with. However, some care plans did not provide suficcient detail where people had complex care needs aor where they needed assistance with tasks that may have resulted in them being harmed or becoming ill if the tasks were not carried out correctly.

Nine care workers said they were unhappy about the training they had received. Some said they had not received any training, and others told us the agency had recently given them workbooks on topics including infection control and food hygiene they had to read and complete in their own time. Following this inspection the provider supplied further information about the training they had given care workers and how they plan to meet training needs in the future.