My Horizon Care Ltd

My Horizon Care is a domiciliary care agency providing personal care to adults living in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. During our inspection visit, the service was caring for 10 people.

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

Feedback from people and most relatives was that care provided was safe and they were confident any concerns raised would be acted upon immediately.

Medication was managed well overall. However, after reviewing all the evidence gathered, we have made a recommendation for the registered manager to make improvements in the recording of medication when this task is the joint responsibility between the provider and relatives of people using the service, to ensure it is in line with best practice and guidance.

Most relevant risks to people’s care were assessed and measures put in place to manage those risks. Staff had a good understanding of how to support people safely and knew what to do if they had concerns about people's safety. Staff had completed safeguarding training and knew how to report concerns. The provider ensured staff followed safe infection control practices and had enough personal protective equipment (PPE).

Staff were recruited safely. People and relatives told us staff mostly arrived on time however, some commented care workers sometimes rushed in and out during their visits. People and relatives told us the service had a positive impact on their lives and staff were kind and caring.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff felt well supported by management. There was a system in place to ensure staff were inducted and shadowed other experienced members of staff. Staff received varied training. The registered manager told us additional training would be put in place for staff, if required, to meet the needs of new care packages.

Regular audits on care, medication and staff's approach were being conducted. However, we found issues identified regarding the recording of medication had not been identified and addressed previously.

Relatives and people knew the manager and most told us they were approachable. The registered manager told us about their plans to continue developing the service.

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 ‘Insufficient evidence to rate’ (published on 17 December 2021) and there were 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.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to initial inquiries to determine whether to commence a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risks to people’s care and medication. This inspection examined those risks.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

My Horizons Care Ltd is a domiciliary care service registered to provide personal care to adults and children. At the time of our inspection, the service was not providing any care. As a result we were unable to provide a rating for this service.

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

We could not gather the experience of people using the service or their relatives because direct care to people was not being provided.

At this inspection, we found some improvements had been made since our last inspection in relation to staff’s training and safe recruitment however, we continued to find gaps and inconsistencies in the planning and recording of risks to people’s care, medicines and the governance systems at the service.

Planning and recording of medicines was not always consistent or in line with the provider's own medication policies and procedures.

The provider was aware of their responsibilities to safeguard adults and children. There were policies and procedures in place. Staff had received training in this area and knew how to apply it.

Care was planned in a way where people were supported to have maximum choice and control of their lives and for staff to support people in the least restrictive way and in their best interests. The policies and systems in place supported this practice.

We continued to find some inconsistencies in the accuracy and completeness of care records. Care plans did not always detail the areas where staff would support people and how this supported would be provided.

There were quality assurance policies and procedures in place but these continued to be ineffective in identifying and addressing the issues found at this inspection.

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 Inadequate (report published 6 April 2021) and there were multiple breaches of regulations.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We carried out an announced comprehensive inspection of this service on 10 February, 1 March and 4 March 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in providing safe care and treatment, ensure staffing is appropriately trained, safe recruitment procedures were followed and good governance systems were in place.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for My Horizon Care on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

My Horizons Care Ltd is a domiciliary care service providing personal care to adults and children. At the time of the inspection it was providing care and support to 10 people. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

There was a lack of clear and accurate documentation relating to people’s care and support, or the management of the service. This meant, in some areas, it was unclear how the service was operating. Records of care delivered were not completed in a consistent way, meaning it was difficult to establish the care and support provided.

Medicines were not managed in a safe way. Assessments of the support people needed with medicines were not carried out and records relating to the support provided were not always accurate or complete. Some risks to people’s health and safety were assessed but this was not consistent, and in some areas, there was an absence of adequate risk assessments. Safe recruitment processes were not always followed, checks on new staff were not suitably robust and adequate records were not available. There were enough staff deployed to ensure people received a consistent service.

Staff received a range of training however no practical moving and handling training had been provided to staff. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We saw evidence the service worked with other health professionals to co-ordinate people’s care and support.

Staff were kind and caring and treated people well. People received care from familiar faces which helped ensure personalised care was provided.

Care plans and risk assessments were in place, although some of these needed more detail. No information on people’s end of life arrangements were recorded. People said they felt able to complain and any minor issues or problems were dealt with by the registered manager.

Relatives said the service was personalised and met individual needs. Staff demonstrated they were committed to the people they supported. However, there was inadequate governance of the service, with the service failing to ensure compliance with regulatory requirements. Records were not available, were provided to us after significant delays and/or the quality and content of the records provided was not sufficient.

Relatives told us they were happy with the care and support provided by the service. They said care was person-centred and reflected individual needs. Relatives said staff were kind and caring and that a consistent team of staff was provided.

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

Rating at last inspection

This service was registered with us on 19/06/2020 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about recruitment and training in addition to us not having inspected the service yet. A decision was made for us to inspect and examine those risks. We planned to undertake a focussed inspection of the safe and well led domains but during the inspection we identified a number of concerns relating to documentation, so we widened the scope of the inspection to become a comprehensive inspection

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led domains of this report. Whilst we did not identify any impact on people, there was the potential for people to come to harm, as risks were not adequately assessed and there was an absence of key documentation.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to risk management, medicines management, record keeping, training and recruitment. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.