Archived: Horizon Retreat

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.

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 is registered to provide accommodation and personal care for up to six people with mental health needs. At the time of our inspection there were six people living in the service, one of whom had been admitted to hospital.

The service had a registered manager in post at the time of the inspection. 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.

People who presented with behaviours which may challenge were not supported appropriately. Risk assessments did not cover all of the behaviours people could present with. Care records did not provide staff with guidance on managing escalating behaviours and staff did not receive any training in the management of people’s behavioural support needs. The provider did not always operate safe recruitment practices, as not all staff files contained appropriate employment references.

People received their medicines safely in line with the prescriber’s instructions. Medicines were stored securely. Staff followed appropriate food safety and infection prevention procedures.

People did not always receive effective care because staff were not trained to meet all of their needs. However, people’s needs were assessed with input from healthcare professionals and staff were supervised. People were supported to eat and drink sufficiently. Staff treated people in line with mental capacity legislation and ensured they had on-going access to healthcare services.

Staff were caring towards people and promoted their independence. Care records were personalised and enabled staff to learn about people’s backgrounds and what was important to them. People’s privacy was respected and staff treated people with dignity.

Staff provided people with person centred care. People were involved in developing their care plans and in reviewing them. Staff monitored and responded to changes in people’s mental health needs and supported people to participate in activities.

The service was inadequately led. The registered manager failed to plan to keep people and staff safe. This was because known risks were not assessed adequately and staff did not receive the appropriate support required to manage problematic behaviours in line with best practice. Where serious incidents occurred at the service the registered manager failed in their legal responsibility to submit timely notifications to CQC. The registered manager failed to ensure all staff were safe and suitable by obtaining appropriate references.

During this inspection, we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.