New Horizon Care provides domiciliary care and supported living services. It provides personal care to a range of people including those with acquired brain injuries, spinal cord injuries, autism and learning disabilities. People being supported, lived in their own houses and flats in the community. At the time of our inspection 45 people were using the service, although not all were receiving personal care. Our inspection only looked at the people who were receiving personal care.

At the last inspection in January 2016, the service was rated ‘Good’.

At this inspection we found the service remained ‘Good’.

Staff received safeguarding training so they knew how to recognise the signs and symptoms of abuse and how to report any concerns of abuse. Risk management plans were in place to protect and promote people’s safety. The staffing arrangements were suitable to keep people safe. The staff recruitment practices ensured staff were suitable to work with people. Where the provider took on the responsibility for the management of medicines, staff followed best practice guidelines. Staff followed infection control procedures to reduce the risks of spreading infection or illness.

The provider understood their responsibility to comply with the Accessible Information Standard (AIS), which came into force in August 2016. The AIS is a framework that makes it a legal requirement for all providers to ensure people with a disability or sensory loss can access and understand information they are given.

Staff received induction training when they first started work at the service. On-going refresher training ensured staff were able to provide care and support for people following current practice. Staff supervision systems ensured that staff received regular one to one supervision and appraisal of their performance.

Where the provider took on the responsibility, staff supported people to eat and drink sufficient amounts to maintain a varied and balanced diet. The staff supported people to access health appointments when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

People were encouraged to be involved in decisions about their care and support. Staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA) and they gained people's consent before providing personal care. People had their privacy, dignity and confidentiality maintained at all times. The provider followed their complaints procedure when dealing with complaints.

People had their diverse needs assessed and met. They had positive relationships with staff and received care in line best practice in order to meet people’s personal preferences. Staff consistently provided people with respectful and compassionate care.

The service had a positive ethos and an open culture. The registered manager was a visible role model in the service. People, their relatives and other professionals told us that they had confidence in the registered manager’s ability to provide consistently high quality managerial oversight and leadership.

We inspected the service on 20, 22, 25 and 28 January 2016. The inspection was announced on all days. The provider was given 48 hours’ notice because the location provides domiciliary care as well as a supported living service for people requiring personal care; we needed to be sure that someone would be in. The service was last inspected on 14 July 2014. During the last inspection the provider was found to be not meeting two regulations. These were in relation to record keeping and staffing. Following that inspection the provider sent us an action plan to tell us about the improvements they were going to make. At this inspection we found that the necessary action had been completed and improvements had been made.

New Horizons Care Limited is a domiciliary agency that is registered to provide personal and nursing care. They provide home support for people with complex neurological conditions, learning disabilities, and other needs. The service also provides support for 6 people to live independently in the community. On the day of our inspection the service was supporting 50 people.

The service did not have a registered manager. The previous registered manager had left in September 2014. 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 and associated Regulations about how the service is run. Management cover had been in place however there had not been a registered manager employed by the service since the previous manager had left.. The provider told us that they were going to apply to become the registered manager.

People and their relatives told us that they felt safe. Risks were assessed and managed to protect them from harm. Staff understood what to do in emergency situations.

People received their medicines as required. Medicines were administered safely.

Staff had received training to meet the needs of the people who used the service. Staff told us that they felt supported but they did not always receive formal supervision in line with the provider’s policies.

Where people required support to make decisions, the service did not always follow the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The staff team were unclear of their role when supporting people who may not be able to make decisions for themselves.

People’s nutritional and hydration needs were assessed and met. People were supported to maintain their health and wellbeing. Systems were in place to monitor the health and wellbeing of people who used the service. People’s health needs were met and when necessary, outside health professionals were contacted for support.

Staff respected people’s homes. People’s independence was promoted and people were encouraged to make choices. Staff knew people well and treated them with kindness and compassion.

People received a consistent level of support. They were involved in the recruitment of staff supporting them. People’s communication needs were identified and support was available for people to enhance their understanding.

The care needs of people had been assessed. Staff had a clear understanding of their role and how to support people who used the service as individuals. People contributed to the planning and reviewing of their care.

The provider had sought feedback from people using the service and their relatives and had acted on what they had said.

Systems were in place to monitor the quality of the service being provided. There were clear lines of communication and people were given the opportunity to have a say on how the service was run.

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

This inspection was announced, this meant we gave the provider 48 hours notice of our visit. At the last inspection on 07 June 2013 the provider was compliant with the regulations we assessed.

New Horizons Care provides support to people in their own homes who have long term neurological conditions, including mental health, learning and or physical disabilities. Packages of support ranged from a few hours a day or week to 24 hours support. At the time of our inspection there were 61 people in receipt of a support package

At the time of our inspection a registered manager was employed at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We found that people did not always receive care and support from staff that were adequately trained, skilled or experienced. People did not always feel confident with the care and support they received.

We identified the provider had some shortfalls with their ability to always plan ahead and respond to changes. The provider had started to recruit more senior staff to address these issues and develop a more responsive service.

People experienced missed or late calls, and were not always communicated about changes of support workers. This meant people did not always receive consistent care and support in line with their assessed needs and plan of care.

The provider had a system and process to review care plans and care packages but we found that there were some errors in the system. Records were not always reviewed or kept up to date.

The provider supported its staff by providing an induction and ongoing training. There were arrangements for staff to receive clinical support and advice at all times.

People told us that they felt their privacy and dignity were respected and made positive comments about staff. Assessments and care plans supported people’ needs and took account of routines, preferences and what was important to the person. People were supported to live their life as fully as possible and to their choice and independence was promoted.

Support workers made positive comments about the leadership and support they received.

We saw complaints and accidents and incidents were recorded. We saw from these records that they had been responded and acted upon in a timely manner. However, people told us they had not always been satisfied with the response they had received about complaints they had made.

We found some breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

People told us the care the agency provided was good. One person said, “I have been dealing with care agencies for many years and this is by far the best. The care is excellent – it couldn’t be better.” Another person told us, “The care is always very good and the staff know exactly what I need.” People said they felt safe using the agency and trusted the staff. One person said, “I have absolute confidence in this agency to look after me correctly.”

People said the staff were appropriately qualified, skilled and experienced. One person told us, “All the staff are well-trained and have done lots of courses.” Another commented, “The staff know what they’re doing. They have training with the agency to make sure of that.”

People told us they were involved in evaluating the quality of their own care and the agency in general. One person said, “My care manager comes to see me every few weeks to check everything is OK.” People also told us managers were proactive if any issues were identified. One person commented, “My care manager is exceptional. She never lets anything go, big or small. She visits me once a fortnight to make sure I am happy with the care I get.”

People told us they were involved in making decisions about their care and support. One person said, “The carers always ask me what I want and I tell them.” Another commented, “The carers help me live in my own home and be independent. That’s what I want and they help me do it.”

People told us the care the agency provided was good. One person said, “I am absolutely happy with New Horizons and everything they do.” Another commented, “The staff know what to do and check in my care plan often to see if there are any changes.”

People said they felt safe using the agency and trusted the carers. They also knew what to do if they had a complaint. One person told us, “If I did have a complaint I would complain to the office but it hasn’t happened yet.” A relative told us, “The staff are trustworthy, I feel I can leave them alone with my relative at any time.”

People told us they liked the staff team. One person said, “All the staff are friendly and helpful. They come on time and are always polite. The agency is excellent and so is everyone who works there.” A relative told us, “The staff have a great attitude. Their timekeeping is good and they are always punctual.”

People said they had the opportunity to get to know their carers because there was a low staff turnover at the agency. One person told us, “I get the same staff all the time. That is important to me.” A relative said, “XXXX tends to get the same main carers which is good as they get to know what her needs are.”

People told us the agency contacted them regularly to get their views on the service. One said, “They come and see me and ask me if I’m happy with the staff and the care.” Another commented, “One of the managers visits me occasionally to check everything is OK.”