Tender-Care Services Limited

Tender Care Services Limited is a domiciliary care agency. It provides personal care to people living in their own homes. At the time of this inspection 58 people were receiving care and support from the service.

People’s experience of using this service and what we found

People received a good standard of care because staff and management put people first.

We saw, and people told us, they received care from staff who knew their needs well, arrived on time and ensured that they felt safe and well cared for.

People were supported by staff who provided flexible, responsive care. Staff recruitment checks were robust and ensured staff were suitable to work with people in a care setting. Staff induction, on-going training and support enabled them to carry out their roles effectively.

People told us they felt listened to and consulted when planning and agreeing what care and support they needed. People were supported to access appropriate healthcare where necessary to maintain their health and wellbeing. Where needed, people received their medication as prescribed.

Risks to people were assessed and regularly reviewed. Staff understood the actions needed to minimise the risk of avoidable harm including the prevention of avoidable infections.

People knew how to make a complaint and felt confident they would be listened to if they needed to raise any concerns.

People and staff felt the service was well led. Governance systems and oversight of the service were robust. Issues were identified, and actions taken to address any shortfalls.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The provider had not made statutory notifications as required. The registered manager updated their procedures to include a step by step process for making notifications.

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

Rating at last inspection

The last rating for this service was Good. (published December 2016)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Tender-Care Services Limited, provides personal care and support to adults who live in their own homes. At the time of our inspection they were providing personal care and support to 73 people.

The service is required by law to have a registered manager, and 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.

Everyone we met and spoke with was content and happy with the service they received. People were provided with support and care by a consistent team of staff who knew them and understood their care and support needs well. People were kept informed of any changes to their timetable or if staff were running late.

Staff were well supported through a range of training that was delivered both face to face and electronically via a computer. Staff received refresher training at regular intervals, to ensure they had the skills and knowledge they required to be able to provide care safely.

Staff told us they were well supported and there was an on-going programme of staff supervision meetings and appraisals to ensure staff performance was monitored regularly.

Quality assurance systems were in place to monitor and where necessary improve the quality of service being delivered.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service caring?

People were treated with consideration and respect. One person told us, 'They listen to me natter. It breaks my day up. I don't get many visitors.' Another person said, 'They are very respectful of me and my husband.' A further person commented, 'They respect my routines.' We saw that staff were polite and considerate when visiting people in their homes. Staff spoke with people with ease and talked about topics of interest to people. For example, one person told us, 'They get to know you personally. They chat about things that interest me.'

People were involved in decisions about their care. We looked at three people's care records which were held in the homes. We found that these records had been signed by the person to indicate their agreement with the content. One person told us, 'The manager came out and we talked about the help we needed before they started with us.' Another person said, 'I was involved in developing my care plan. The times of the calls, and all the things that need doing.' A further person commented, 'I only want female staff so that's all they send.'

Is the service responsive?

People received the support they required at the time they needed it. One person told us, 'They are rarely late.' Another person said, 'They always turn up.' Staff arrived on time for the three visits we made to people's homes. People told us that the agency was responsive to their needs. One person told us, 'They are very flexible. If I need to change the time they come for some reason, they have always made the change.' Another person said, 'They are so flexible. They don't start until 7am, but we had a hospital appointment so they came at 6am to help him get ready.'

The provider had a system in place to deal with emergencies. The manager told us that there was a person on call outside of office hours and during their hours of business. Staff could contact the on call person for advice and guidance. We saw that the provider had an on call folder which contained information such as staff contact details, contact details for equipment repairs and people's emergency contacts. We found that there was a procedure to follow in the event of staff not being able to gain access to a person's home.

Is the service safe?

People were told in advance of the staff who would provide support to them for the week. The manager told us that each person was sent a schedule that detailed which staff would attend each visit. One person told us, 'I always know who is coming in. They send a list through on a Saturday and it generally stays the same.' Another person said, I have a list that comes through every week telling me who is coming in.'

The provider had a policy detailing the actions to take if abuse was suspected. This policy provided information regarding abuse and the actions which needed to be taken and the reporting arrangements. The policy detailed the need to take immediate action to protect the person and the contact numbers for external agencies such as the local authority safeguarding team. We saw that a poster displaying the actions to take if abuse was suspected was displayed prominently in the office and contained contact details for relevant external agencies. The provider may find it useful to note that the policy did not contain information regarding the requirement to inform the Care Quality Commission (CQC) of any allegation of abuse. However, the manager was aware of the need to inform CQC. The provider had access to the local multi agency safeguarding policy which provided details of the local arrangements for safeguarding vulnerable adults.

Is the service effective?

People's needs were assessed and care was planned and delivered to meet their needs. We looked at three people's care records which were held in their homes. We found that plans were in place which detailed the care which staff were to provide and these were followed by staff. For example, one person's plan stated that they required assistance to use the toilet and for their catheter bag to be emptied on one visit. We saw that that staff supported the person with these activities. Where people required the use of moving and handling equipment such as hoists we found that there was a detailed plan in the person's home directing staff as to how this equipment should be used. One person told us, 'They always follow the plan and do everything I need. When they have finished they always ask if there is anything else I need.' Another person said, 'It's all written down in my folder.' A further person commented, 'They have a care plan to follow.'

People told us that their needs were met. One person told us, 'You couldn't have better care than I'm getting.' Another person said, 'If I didn't have their help I wouldn't be able to stay at home.' A further person commented, 'They meet all his needs and he is very happy with the carers.'

Staff received training in a variety of relevant topics. For example, we found that the majority of staff had received training in safeguarding and infection prevention and control. One person told us, 'I feel they are very well trained. They have never had any problems using the equipment.' Another person said, 'They all know how to use my hoist.'

Staff were supported and supervised to carry out their roles. The majority of staff had received an annual appraisal and had regular 'spot checks' of their performance. Staff told us that they felt supported and found the feedback from spot checks useful in their development. New staff were supported in their roles. One person told us, 'The two who were here this morning only started a couple of months ago. They did a couple of shadow shifts with the regular staff and now come in on their own and do it perfectly.' Another person said, 'The new ones shadow the trained ones and learn as they go.' A further person commented, 'They are very competent. The newer ones come with the older ones.'

Is the service well led?

People were able to express their views of the service. One person told us, 'I feel able to complain. I have complained about a carer who was never on time. She doesn't come anymore.' Another person said, 'I am able to make complaints and the manager would sort them out.' A further person commented, 'They are open to complaints.' We found that the provider carried out an annual survey. We looked at the most recent survey which asked for people's views on a variety of topics such as, timekeeping, privacy and whether staff met people's needs. The responses to the survey were largely positive.

Senior staff and managers regularly checked on the quality of the service. One person told us, 'The management comes out to actually do the work.' Another person said, 'I am so confident with the manager. She is always checking that all is well.' A further person commented, 'The manager is very hands on. When she comes out she looks through all the care plans and checks what the carers write.' We found that there was a process of regular checking of staff performance through 'spot checks' which focused on aspects of care such as infection prevention and control practices, moving and handling and staff dress. We spoke with four staff who confirmed that their performance was regularly checked and that they felt that this was supportive.

Care plans that we looked at evidenced staff supporting people to make their own choices about what they had for lunch, what activities they took part in and what they needed support with. Staff knew exactly how each person communicated which meant people's wishes were understood and respected.

Records that we looked at evidenced that people were involved in choosing how and when they wanted their care and support. This indicated that people were involved in planning their care on a daily basis.

A family member told us "they are all fantastic ' I couldn't ask for more" and another said "they are all really easy to talk to and approachable."

The purpose of our inspection was to check whether the provider had complied with their legal obligations concerned with the recruitment of staff. At a previous inspection of the service carried out on 8 October 2012 we had found that care workers had started their employment before all the statutory required checks into their suitability to work with vulnerable adults had been completed.

We did not speak to anyone who used the service but we looked at relevant documents and records.

On this occasion we found that only one new care worker had started work for Tender-Care Services Limited since our last inspection and the provider had suitable staff recruitment procedures in place.

Our inspection took place over two days starting on 8 October 2012. On the first day we looked at documents held at the office of Tender Care and spoke with care workers. On the second day with their permission we visited five people in their own homes. We were accompanied by one of Tender Care's directors and we spoke with individuals who received care and support or their relatives.

Everyone we spoke with was complimentary about care workers and described them as 'kind' and 'helpful'. They also said they were 'polite', 'respectful' and helped support them to remain independent. People told us care workers were usually prompt and there was continuity of care provided by a regular team of staff.

People said they received the help they needed and they knew how to complain if they were dissatisfied.

Care plan documents that set out the help people needed were concise, accurate and up to date. We saw there were copies of individuals' care plans held at the office of Tender Care Services Ltd as well as at people's own homes.

We saw that there were some systems in place that ensured some of the registered provider's procedures were followed and the quality of the service people received was maintained and/or improved.