Archived: Horizon Retreat

Updated 20 September 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

One inspector carried out this inspection.

Service and service type:

Horizon Retreat 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

The inspection visit took place on 22 August 2019 and was unannounced.

What we did:

Before the inspection we reviewed the information we held about this service including notifications the provider is required by law to send us about events and incidents involving people. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

During the inspection we spoke to two people using the service. We also spoke to the registered manager, the deputy manager and a care support worker. We looked at two people's care records, medicines administration records (MARs) for three people, three staff files and other records relating to the management of the service including policies and procedures.

Updated 20 September 2019

About the service

Horizon Retreat is a residential care home providing personal care to up to six people in one adapted building. The service specialises in supporting people with mental health needs. There were three people using the service at the time of this inspection.

People’s experience of using this service and what we found

The quality and safety of the service had improved for people since our last inspection. Staff had been provided training to help them manage difficult behaviours to keep people and them safe. Information about people’s behavioural support needs had been improved to help staff reduce the risk of these escalating. Changes had been made to recruitment practices to reduce the risk of people being supported by unsuitable staff.

The provider had implemented systems to assess and monitor the quality and safety of the service. There were now audits and checks of key aspects of the service and the provider made sure action was taken to address any issues identified through these checks.

The registered manager now fully understood their responsibility for meeting regulatory requirements. They notified us, without delay, of events or incidents involving people which helped us check that appropriate action was taken to ensure the safety and welfare of people in these instances.

Although the provider had acted to make improvements, it was too early to judge whether these could be maintained continuously over time. Many of the positive changes we found had been made in the months prior to our inspection which meant there was not enough evidence of consistent good practice over time.

We also found some areas of the service continued to need improvement. Some records had not been maintained in a consistent way so that they contained up to date and accurate information about people. This was not having a significant impact on people at the time of this inspection but may present a risk in future.

Some of the activities planned for people were not always relevant to their social and cultural needs. We have made a recommendation about the provision of activities for people.

People were not being fully supported to achieve their care goals. Plans for how people would develop the skills they needed to move on from the service with a view to living independently were not fully developed. However, people’s records contained information for staff about how they should be supported with their physical and mental health needs. We have made a recommendation about helping people to set and achieve goals for independent living.

People told us their needs were met by staff. Staff helped people stay healthy and well. They supported people to eat and drink enough to meet their needs and to take their prescribed medicines. Extra help was sought for people if they needed this, for example when they became unwell. Recommendations from healthcare professionals were acted on so that people received the relevant care and support they needed in relation to their healthcare needs.

People said they were safe at the service. There were adequate numbers of staff to support people safely. Staff had been trained to safeguard people from abuse and knew how to manage identified risks to people. The provider carried out health and safety checks of the premises and equipment to make sure they were safe. The premises were clean and tidy and provided comfortable spaces for people to spend time in. Staff followed good practice when providing personal care and when preparing and handling food which reduced hygiene risks.

Staff received training to help them meet the range of people’s needs and were supported by senior staff to continuously improve their working practices. The registered manager made sure staff were motivated and clear about their duties and responsibilities, to help people achieve positive outcomes in relation to their care needs.

Staff were warm and friendly with people. They supported people in a dignified way which maintained their privacy and independence. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People knew how to make a complaint if needed. The provider had arrangements in place to make sure any accidents, incidents and complaints were fully investigated which included keeping people involved and informed of the outcome. Learning from complaints and investigations was acted on and shared with staff to help them improve the quality and safety of the support they provided.

People, staff and the local community were encouraged to have their say about the service. The registered manager used their feedback to identify ways the service could further improve. The provider worked with other agencies to make improvements. They acted on recommendations made by others to improve the quality and safety of the service for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (published 27 February 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However, the service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Enforcement

At the last inspection we found the provider had failed to notify the Commission of events and incidents at the service. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.