Archived: Horizon Close

Horizon Close 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.

Its aim is to provide maintenance and rehabilitation programmes for adults with long-term neurological conditions. Accommodation is organised into ten bungalows and is one of six adult social care locations which also has a hospital that is registered separately with CQC. Glenside Manor Healthcare Services is not close to facilities and people may find community links difficult to maintain.

Each of the services is registered with CQC separately. This means each service has its own inspection report. The ratings for each service may be different because of the specific needs of the people living in each service. While each of the services are registered separately some of the systems are managed centrally for example maintenance, systems to manage and review accidents and incidents and the systems for ordering and managing medicines. Physiotherapy and occupational staff cover the whole site. Facilities such as the hydrotherapy pool are shared across the whole site.

The hospital was closed at the time of our inspection due to flood caused by a major water leak in January 2019. Patients from the hospital were transferred at short notice to some of the adult social care (ASC) locations.

People’s experience of using this service:

The provider failed to apply for an extension of the regulated activity to accommodate hospital patients in ASC locations. Although the provider had notified us of the temporary arrangements for hospital patients while refurbishments were taking place. We informed the provider at the time and at inspections that to continue offering accommodation to hospital patient’s they must submit applications to CQC. This was to ensure hospital patients were cared for in a manner that met the regulated activity.

People were not safeguarded from abuse and were placed at some risk of harm.

Medicines were not well managed and the potential for errors was increased.

The service was not well led. The management had not taken action in response to events that had or could cause harm to people. There have been persistent changes of senior managers. There was a lack of regulatory response from the provider.

Rating at last inspection:

The overall rating at the focus inspection dated 7 November 2018 was Requires Improvement. This report was made final on 20 February 2019. The overall rating of this service was changed to Inadequate.

Why we inspected:

This inspection was brought forward due to information of risk or concern about people living in all ASC locations. After the inspections of other ASC locations CQC requested assurances from the provider about the action they would take to improve the service. The responses provided by the provider did not give assurances that the service would improve.

Enforcement:

Following the last inspection we imposed a condition on the providers registration to submit monthly improvement action plans to CQC. The action plans provided did not give assurances that the service would improve.

Follow up: This service has been placed in special measures. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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.

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

The team inspected the service against one of the five questions we ask about services: is the service well led. This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvement were identified in the remaining Safe, Effective, Caring and Responsive through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

The aim of Horizon Close is to provide maintenance and rehabilitation programmes for adults with long-term neurological conditions. Accommodation is organised into ten bungalows and is one of six adult social care locations which also has a hospital that is registered separately with CQC. Glenside Manor Healthcare Services is not close to facilities and people may find community links difficult to maintain

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.

A registered manager was in post. 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.

At the previous inspection dated 10 October 2018 we found a breach of Regulations 9, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider following the inspection to tell us how they were going to meet the legal requirements of these regulations. . Following the inspection, the provider failed to report within the timescale specified the intended actions to meet breaches of Regulations. At this inspection we found continued breach of Regulation 17.

following the inspection we formally requested under Section 64 of the Health and Social Care Act 2008 to be provided with specified information and documentation by 16 November 2018. We received some of the information requested but not all.

Quality assurance systems were inadequate. Audits were not robust and did not provide an accurate assessment of the quality of care delivered. Action plans were not developed to drive improvements.

Recruitment procedures did not ensure the staff employed at the home were suitable to work with adults at risk. We received whistleblowing concerns about staff not able to speak sufficient English and that agency staff were working without appropriate checks. We found there were some staff working across the site without the appropriate disclosure and barring checks or references in place. Relatives also expressed concerns about staff who were not able to speak or understand English.

Staff morale was poor and staff told us they feared about their jobs as they had witnessed other staff being dismissed almost daily. The staff survey indicated that 13 of the 38 staff responding would recommend the home. There were agency staff working as well as accommodated at Glenside Manor whose identify could not be confirmed by senior managers.

People’s health, safety and welfare were placed at risk because not all staff working in Glenside Manor locations were appropriately trained. Staff from other Glenside Manor locations as well as agency staff cover shifts at Horizon Close. The training matrix provided had identified that 86% of staff had attended training set by the provider as mandatory. Evidence was not provided that all staff as well as agency staff working at Glenside Manor locations including Horizon Close were appropriately trained.

The maintenance of equipment was not managed safely and placed people at risk of harm. The maintenance staff were undertaking checks of fire alarm system, boiler checks and legionella. However, there was no proof of their qualification or competency to carry out checks and maintenance of equipment.

We received whistleblowing concerns about the competency of the staff undertaking maintenance checks of systems and equipment. We requested proof of the competency of these staff from the provider. The documentation provided did not give us reassurances that staff undertaking maintenance checks were skilled or competent.

The provider had notified us of some incidents reportable under the Care Quality Commission (Registration) Regulations 2009. There were other incidents and accidents in relation to reportable incidents of significant risk towards people and others that may be reportable us. For example, unplanned admission to hospital. Incidents that prevented the safe running of the home were not reported.

The information received from relatives about raising concerns was not consistent with the complaints log received for Glenside Manor locations.

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.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. There were widespread and significant shortfalls in the way the service was led. The delivery of high-quality care was not assured by the leadership, governance or culture in place.

This means that it has been placed into 'Special measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action. 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.

At the time of the inspection, there were five people using the service. It 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.

At the inspection dated June 2017 we rated this service as Requires Improvement with a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We received an action plan from the provider telling us how the regulation was to be met following the inspection. At this inspection we found this action was completed.

This is the second consecutive time the service has been rated Requires Improvement.

A registered manager was in post. 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.

The staff at the home were not aware who the registered manager was, they had assumed the unit manager had this role. The unit manager said they had day to day management responsibility for this service including staffing. The staff said the team worked well together and the unit manager was approachable.

People we asked were unsure if they had a care plan in place. While the unit manager told us people’s needs were assessed before their admission, copies of assessments were not in place. For one person the staff had reviewed the care plans from the previous placement as current to Horizon.

There were aspects of person centred care plans but care plans were not in place on how people were to be supported with their discharge or developing the skills to live independently. People told us discharges were not well planned.

People had access to a GP and on-site health care services. There were concerns whether people were having satisfactory physiotherapy. People told us they were promised daily allied healthcare support such as occupational and physiotherapists. They said the therapists support was to help improve their abilities with functioning. People raised concerns about the lack of allied healthcare staff and that these staff were leaving. People and relatives told us their sessions were often either cancelled or started later than expected.

Quality assurance systems were not effective because audits used to assess the quality of service were not detailed or covered all areas of people’s care delivery. Where shortfalls were identified, action plans were not devised on how to fully meet the outcomes assessed. Some audits had identified the outcomes assessed as complete. This was not reflective of the inspection findings.

The unit manager told us there was continuous learning from reporting processes which gave staff confidence to report accidents and incidents appropriately. There had been a number of events including theft, poor practice from staff and failure of heating systems. However, these had not been reported to CQC. This meant CQC were not able to assess the follow up action to take.

Complaints were not always resolved. People told us they could discuss any issues with the staff. One relative told us therapies promised did not materialise. This relative said they had made numerous complaints.

People were expected to clean their own bungalow but needed support because of their mobility impairments. We found some bungalows were not always clean.

The risk to people that self-administered their medicines and to others was not assessed and action plans were not devised on how to lower the potential risk to people and others. Audit systems and accident reporting show there had been medicine errors.

Medicines were stored in lockable spaces in people’s bungalows and staff administered medicines in people’s personal space.

The staff we spoke with knew the types of abuse and to report their concerns. They said they had attended safeguarding adults training to help them recognise the signs of abuse and about reporting concerns. People felt safe because they had confidence in the staff. We received whistleblowing concerns which included lack of staffing which restricted the rehabilitation support available.

The people at Horizon had capacity to make decisions.

People and relatives were positive about the skills of permanent staff. The staff told us the training provided by the organisation was good and was onsite.

People were mainly self-sufficient with meals. The staff supported people to plan their menus and supported them with weekly shopping for their meals. For those that took up the option of having their meals catered at Glenside hospital, there was a choice of meals which people selected two days in advance.

The unit manager told us the challenge for the service was supporting people to discharge with lower staffing levels. This manager said people may expect a “faster pace for discharge. We agree on a transition plan. For example, cooking skills. There is more freedom [at Horizon]. It’s worthwhile preparing people but there is less staff around for this.”

We found breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Horizon Close was registered as an adult social care location in August 2016. Previous to this, the location formed part of the overall site of Glenside. This was the location’s first inspection, as part of the adult social care directorate.

There was a registered manager in post. 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. The registered manager was available throughout our inspection.

There were systems in place to assess, monitor and mitigate risks relating to the health, safety and welfare of people. A traffic light system was used, which identified any shortfall and its level of risk. Records showed further checks were completed to ensure compliance. However, audits had not identified that two staff had not completed fire safety refresher training or that a day and night time fire drill had not been undertaken. This was despite the fire drill being identified as a 'level one' priority. After the inspection, a senior manager told us fire training was monitored on a monthly basis and formed part of the monthly quality report. A fire test was completed on the day of the inspection.

There was a positive approach to risk management. However, not all risks associated with each person’s bungalow had been consistently considered. Staff supported people to think about risk taking and how they should do this safely. There were a range of assessments to identify and assess potential risks. The assessments were clear and up to date. Systems were in place to support people to manage their medicines safely. Each person was on a medicine “pathway”, linked to their ability. As the person’s competence and confidence increased, they moved further along the pathway until they were fully independent with their medicines.

There was a strong emphasis on rehabilitation to enable people to reach their potential and move to more independent living. Each person had a clear support plan which they were fully involved in developing. The information detailed individual goals and regular assessments were undertaken to monitor progress. In addition to receiving support from the rehabilitation staff, people were well supported by specialist services. This included an on-site team of professionals such as psychologists, occupational therapists and physiotherapists. All sessions were built into each person’s weekly plan and there were weekly multi-disciplinary meetings to discuss progress.

People were supported with meal arrangements if needed. This included support with tasks such as making a shopping list, purchasing food and cooking the meal. People were encouraged to be as independent as possible. Some people did not require any support in this area. Other areas of support included budgeting, housekeeping, accessing community services safely and using public transport.

There was an open approach to complaints and clear processes were in place. Records showed any complaints were properly investigated and a satisfactory outcome was reached. People knew how to make a complaint and were encouraged to give their views about the service. They did this by attending regular meetings and completing satisfaction surveys. Action had been taken in response to people’s requests. This included new furniture of a homely nature in the main lounge.

Safe recruitment processes were in place and there were sufficient numbers of staff to support people effectively. All new staff received a detailed induction when starting at the service. This was regularly reviewed and enabled each staff member to be clear of their roles and responsibilities. Staff received a range of training deemed mandatory by the provider and felt well supported. One to one meetings with the manager were regularly held. This enabled staff to discuss their work and any concerns they might have. Staff received annual appraisals. Records showed they appraised themselves but the discussions or the action plan for the following year were not always documented. There were regular staff meetings and handovers of information. Staff showed they were aware of people’s needs and established relationships had been built.

During our inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.