Tender-Hearted Limited

Updated 22 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

This was a targeted inspection to check whether the provider had met the requirements of the Warning Notice in relation to Regulation 17 Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Inspection team

The inspection was carried out by 2 inspectors.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority service improvement and safeguarding teams. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We reviewed written feedback records from 9 staff and 6 people who use the service. We received written feedback from 1 relative of a person who uses the service. We reviewed a range of records. This included 17 people's care records and 7 medication records. We looked at 6 staff files in relation to recruitment and a variety of records relating to the management of the service.

Updated 22 July 2023

About the service

Arena Business Centre is also known as Tender-Hearted Care. Tender-Hearted Care is a domiciliary care agency and provides personal care to adults living in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. 18 people were receiving personal care at the time we inspected.

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

People told us the registered manager and staff were kind, caring and their needs were met. One person told us, “Best care I have ever had. The staff are so caring, so hands on, they would do anything to help.”

The provider, also the registered manager was open and transparent throughout the inspection. They told us their focus had been providing hands on care to people using the service and working with new staff to Tender-Hearted Care. This meant they were unable to oversee the running of the service. We found the lack of oversight and governance had led to our inspection identifying areas of improvements.

People had been recruited into the service without complete background checks. Systems were not in place to robustly check the recruitment process.

Medicines were not managed safely. Medication administration charts (MAR) had not been completed and showed people did not always get their medicines as prescribed. Systems and processes had failed to identify MAR were not completed.

We found that people who lacked capacity had not always been assessed and reviewed within the principles of the Mental Capacity Act 2005 (MCA). This meant, people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Systems and processes were not robust to ensure good governance of the service. Frameworks were not in place to ensure good quality care could be delivered consistently. Audits were either not in place or not robust to identify any concerns. There was not a robust accident and incident reporting system in place. This meant any areas of improvements were not identified, themes and trends were not identified and placed people at risk of not having their care needs met and safeguarded against.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support:

People were not supported to have maximum choice and control of their lives, this meant staff were unable to supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care:

People's care, treatment and support plans had not always been updated and did not show how people had been involved. The service had identified care plans were not up to date and were in the process of updating them.

Staff had training on how to recognise and report abuse and they knew how to apply it. Systems and processes needed to be improved to ensure the service identified and protected people from abuse.

People received kind and compassionate care. Staff protected and respected people's privacy and dignity.

Right Culture:

The quality of the care people received had not always been monitored and reviewed to ensure people's needs were met.

People and those important to them, including advocates, were involved in planning their care.

Staff had access to personal protective equipment (PPE) and people told us staff wore this appropriately, kept their homes clean and were regularly observed to wash their hands.

Staff knew how to recognise signs and symptoms of abuse and who to report their concerns to. People told us they felt safe with staff.

Staff felt valued, supported and appreciated by the registered manager. Staff told us they felt proud to work for Tender-Hearted Care and felt people received good care.

People had their needs assessed before care was delivered. The service had good working relationships with social workers and arranged healthcare professionals as required.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 December 2021). The service remains rated requires improvement.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 17 November 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe recruitment of staff into the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Arena Business Centre on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the management of medicines, good governance of the service, safe recruitment of staff into the service and the making of appropriate statutory notifications to CQC.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.