Horizonz Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to range of people including older and younger adults. At the time of the inspection the service was providing personal care to 28 people. The service also provides social inclusion support to other people who use the service. This aspect of the service does not require registration with the Care Quality Commission and is not included within the scope of this inspection.

We visited the provider’s office on the 29th August 2018 and made phone calls to people, staff and relatives between the 17 August and 7 September 2018. The inspection was announced. This meant we gave the provider a short amount of notice that we would be visiting.

At the last inspection in July 2017 we rated the service Requires Improvement. We found two breaches of regulation, one relating to unsafe recruitment practices and the other as the service was not acting within the legal framework of the Mental Capacity Act (MCA). At this inspection we found overall, the service was acting within the legal framework of the MCA and obtaining consent lawfully with improvements evident in this area. However, we found safe recruitment practices were still not being followed which meant the service was still in breach of this regulation. Because the provider had failed to improve in this area we also concluded governance systems were not effective. This led us to also find the provider in breach of another regulation relating to Good Governance.

We also found there were many areas where the service performed well. People and relatives provided good feedback about the service. They said they received good, personalised care from kind and caring staff. People said they had familiar care workers who knew them well. People said the management team were warm and friendly and willing to address any issues they had. We found the management team and staff to have good caring values and demonstrated a commitment to providing people with personalised care and support.

People said they felt safe using the service. Risks to people’s health and safety were assessed and clear risk assessments produced for staff to follow. Staff knew people well and how to care for them. Action was taken following incidents and accidents to help keep people safe.

People received appropriate support with their medicines and clear records were kept to evidence this.

There were enough staff deployed to ensure people received a timely and reliable service. Staff said they did not have to rush and had time to complete care tasks to a high standard. However staff were not always recruited safely, as references had not always been obtained for new staff from previous employers. Staff received a range of training and support relevant to their role.

People said they received appropriate support at mealtimes. People’s care needs were assessed and detailed plans of care were put in place. These were personalised and provided staff with clear instructions on how people liked their care to be delivered. The service worked with health professionals to help ensure people’s healthcare needs were met.

The service was acting within the legal framework of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

People said they were treated with dignity and respect by staff. People had a small group of care workers who got to know them well. New staff were introduced to people before they worked with them.

People said they felt listened to and valued by staff. Any complaints or issues were dealt with appropriately.

Audits and checks were undertaken by the service. However, these were not always thorough enough as they did not always pick up errors in care documentation. Systems and processes should also have been operated to ensure improvements were made to recruitment practices.

We found two breaches of the H

We inspected Horizonz Care on 20 July 2017 and it was an announced inspection.

Horizonz Care is a domiciliary care agency that provides personal care for people living with dementia, mental health needs, physical, sensorial and learning disabilities in their own homes. At the time of this inspection they were supporting 25 people.

There was a registered manager in place. 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 last inspection the service was rated required improvement and had two breaches of regulation related to safe care and treatment and good governance. At the last inspection on 08 August 2016, we asked the provider to take action to make improvements to their processes in relation to supporting people with medication and good governance. At this inspection we found that the service had made improvements and was no longer in breach of regulation for safe care and treatment in good governance. However, we found the service was breaching regulations concerning safe recruitment and consent.

People who used the service were protected from the risk of harm and abuse. There were policies in place in relation to safeguarding and whistleblowing procedures. Care workers understood these policies.

People's risks had been assessed and there were plans in place to minimise and manage those risks.

New employees were checked before they could work with people but this practice was not always consistent.

People told us that care workers turned up on time to provide care and there were enough care workers to support people.

People’s medicines were not always managed safely. People and their relatives told us that medication was given on time and not missed. There were no protocols for ‘as and when’ required medication or creams. We found that staff’s competencies and medication audits were not robust.

Care workers completed an induction to ensure they were aware of their roles and duties. They were provided with regular supervisions to assess and monitor their performance and wellbeing.

People told us they were treated with respect and dignity. They said they were always given a choice and care workers respected their decision.

People's support needs were assessed prior to receiving support from the service. Care plans were detailed and personalised to people’s care needs and preferences.

People are supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

The registered manager was able to explain their responsibilities under the Mental Capacity Act 2015 however, we found inconsistency in the mental capacity assessments sampled; some were very detailed but others were not decision specific.

People and their relatives told us they thought the service was well managed. We found there were arrangements in place to monitor the quality of the service but these were not all equally robust.

The inspection of Horizonz Care took place on 16 June 2016 and was unannounced. We previously inspected the service on 6 January 2016. At that time we found the registered provider was not meeting the regulations relating to dignity and respect, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, complaints, good governance, staffing and fit and proper persons employed.

The registered provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked to see if improvements had been made.

Horizonz Care is registered to provide personal care. Care and support is provided to people who live in their own homes within the localities of Dewsbury and Huddersfield. On the day of our inspection 26 people were receiving support with personal care.

The registered provider is also the registered manager for the service. 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 told us they felt safe. Staff had received training in safeguarding vulnerable people and were able to tell us the action they would take in the event of anyone being at risk of harm or abuse.

A number of risk assessments had been implemented since our last inspection, these included details of the equipment staff needed to use to enable safe moving and handling of people. Emergency contact information was recorded in each of the care plans we reviewed but this information did not record the location of emergency cut off points for the utility services in people’s homes.

Our inspection on 6 January 2016 found that recruitment procedures were not thorough. At this inspection we found some improvements had been made, for example Disclosure and Barring Service (DBS) checks were recorded for staff. As no new staff had been employed since our last inspection we were unable to evidence safe recruitment procedures had been implemented by the registered provider.

People told us staff were on time and did not miss calls. The registered person told us they implemented an electronic monitoring system; this alerted them in the event a person’s call was late or had been missed.

Staff had completed medicines training but the document used to assess staff competency in medicine administration lacked detail. Improvements had been made to the recording of people’s medicines but we saw gaps on medicine records and not all the entries contained adequate information to enable safe administration by staff. This evidenced a continuing breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Since our last inspection staff had completed a variety of online training courses. They had also attended a practical training session for moving and handling of people. Staff had received supervision, although this was not always documented.

Staff we spoke with understood people’s right to make decisions about their daily lives. Where people lacked mental capacity, assessments were in place in their care plans, however, these needed further development to ensure they were specific to the decision they related to.

Where people were unwell, we saw evidence they had been supported to receive medical advice.

People told us staff were kind and caring. Staff spoke to us in a caring manner about the people they supported. Staff were able to describe the steps they took to ensure people’s privacy and help them to retain a level of independence.

Records relating to people and staff were stored securely.

People had a care plan in place. Staff said the care plans were reflective of people’s current care needs and we saw evidence care re