CQC takes action to protect people at Exeter Care Agency

The Care Quality Commission (CQC) has downgraded the rating of Horizon Care (South West) Ltd from good to inadequate and placed it into special measures to protect people following an inspection in September.

Horizon Care (South West) Ltd, run by a company of the same name, is a domiciliary care agency providing personal care to 236 people living in their own homes in Exeter.

CQC carried out the inspection after receiving information of concern about the service.

Inspectors found the service was in breach of nine regulations relating to safeguarding, safe care and treatment, person-centred care, consent, staffing, dignity and respect, required notifications to relevant organisations, fit and proper persons employed, and the management of the service.

Following the inspection, CQC issued Horizon Care (South West) Ltd with a warning notice to highlight the areas where rapid and significant improvement was needed, particularly in safe care and treatment, safeguarding, and how leaders were overseeing the service.

CQC has downgraded the ratings for being safe, effective, responsive, and well-led from good to inadequate. The rating for caring has dropped from good to requires improvement.

CQC has also placed the service into special measures, which involves close monitoring to ensure people are safe while they make improvements. Special measures also provides a structured timeframe so services understand when they need to make improvements by, and what action CQC will take if this doesn't happen.

Stefan Kallee, CQC’s deputy director for adult social care in Devon, said:

"When we inspected Horizon Care (South West) Ltd, we found leaders hadn't identified the serious problems themselves in how the service was being run. This lack of understanding about the issues the service faced meant people weren't always getting the safe, person-centred care they needed and deserved.

"These issues had an effect on people, as some didn't always feel safe with the carers supporting them. People told us their visits weren't always carried out when support was needed, and visit times were often changed without notice, leaving people unsure who to expect or when staff would arrive. One person described feeling anxious when care staff were late and it made them worried they might not come at all.

"We found that safeguarding concerns and incidents of potential abuse were not always documented or reported to the local authority as they should have been. The local authority confirmed that it had received multiple safeguarding referrals involving the service, however these were not always raised by the service itself.

"People didn't consistently receive critical medication as prescribed because staff didn't always visit at the agreed times. Staff told us there were occasions where visits were delayed and time-sensitive medications were given late as a result.

“Leaders didn’t make sure care plans had enough detail in them so staff could provide safe and effective support. For example, a person with type 2 diabetes received help with meals and personal care, but their plan provided no guidance on diet, diabetic emergencies, or foot care, putting them at risk of serious complications such as diabetic emergencies, foot ulcers and infections.

"However, we did observe some compassionate and caring practice from long-standing staff who had developed trusting relationships with the people they were supporting.

"We've told leaders at Horizon where they must make immediate and significant improvements, and we're monitoring them closely to keep people safe while this happens."

Inspectors found:

• Leaders failed to identify serious problems with service management, putting people at risk of poor care and failing to protect their rights.
• The service failed to complete adequate risk assessments, leaving people vulnerable to avoidable harm.
• Staff didn’t always know how to raise concerns outside the organisation, and some told inspectors they didn’t not feel able to speak up about unsafe practice.
• People told inspectors the service didn’t respond consistently when they raised concerns about their care, and some said they were afraid to complain in case they lost their care package.

The assessment will be published on CQC’s website in the coming days.