Tendring 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 predominantly to older people. People using the service lived in 23 residential houses and ordinary flats across Clacton on Sea, Frinton on Sea, Tendring and the surrounding areas. Not everyone using Tendring Care receives personal care; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of the inspection the registered provider was providing support to 23 people.
A registered manager was in post. The registered provider was also the provider of this service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
At the last inspection in January 2016, the service was rated 'Good'. At this inspection we found the service had achieved a rating of ‘Requires Improvement’'. We wrote to the provider following this inspection and met with them to further discuss our concerns and the way forward to ensure the service achieved rating of at least ‘Good’
During this inspection we found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.
The care files we reviewed contained very basic information and did not contain any person centred information. Care plans were being reviewed but they did not highlight the areas of concern we identified during our inspection.
Risk assessments were implemented but did not contain clear guidelines for staff on how to support people and minimise risk levels. People were protected from the risk of abuse. Staff had received training around this. There were recruitment systems in place however; procedures for these were not followed consistently.
The service provided to people was not fully effective in meeting their needs. Staff had the relevant skills; however had not all received appropriate training to enable them to support people. Staff received good support from management through regular supervisions and appraisals however these needed to be more detailed in their approach.
People were encouraged to make day to day decisions about their life. For decisions that were more complex and where people did not have the capacity to consent, the staff had acted in accordance with legal requirements.
Where required, people and relevant professionals were involved in planning their nutritional support. Where required, people were support to access a variety of healthcare professionals and appointments were arranged, however we saw little information in the care plans to support this..
People and their relatives spoke positively about the staff. Staff did not always demonstrate good understanding of respect and dignity. People's preferences in relation to their cultural or religious backgrounds were only briefly recorded. Equal opportunities and diversity were not fully promoted throughout the service.
People and their families were provided with opportunities to express their needs, wishes and preferences regarding how they lived their daily lives. People's needs were assessed, however care plans did not provide clear guidance to staff on how people were to be supported. The registered provider did not fully evidence or promote person centred care and support for people.
Where complaints had been made, there was evidence these had been managed appropriately.
The service was not always well-led. Quality assurance checks and audits were occurring regularly but did not always identify shortfalls within the service. During this inspection, we found that the systems and processes in place to maintain the quality and the standard of care being provided had not been effectively implemented. Records were very basic and did not evidence the most relevant information in relation to the support needs of the person.
Audits systems and checks were not being used effectively, there were not any measures in place to monitor, assess or improve the delivery of care being provided. Audits/checks, which were in place, did not effectively measure the quality or standard of support being provided. Feedback from the people who were being supported or their relatives had not been formally gathered. This meant that there were not any systems in place to gather feedback about what the registered provider does well or what areas need to be improved on.
Staff, people and their relatives spoke positively about the manager. There was a positive culture within the service and staff demonstrated a good understanding of the vision and values of the service.
We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and have made two recommendations with regard to Recruitment procedures and Communication.
You can see what action we told the provider to take at the back of the full version of this report.