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Inspection carried out on 26 February 2019

During a routine inspection

About the service:

Tendring Care is a domiciliary care service that provides support and personal care to older people in their owns homes within the Clacton area. At the time of our inspection the service was supporting 24 people with personal care.

People’s experience of using this service:

At our last inspection in December 2017, the service was rated requires improvement overall. The key questions for safe, effective, caring, responsive and well led were rated requires improvement. There were breaches of Regulation 9: Person centred care, Regulation 10: Dignity and respect, Regulation 12: Safe care and treatment, Regulation17: Good Governance and Regulation 18: Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this inspection, we found improvements had been made.

The registered manager had implemented new systems to record any checks that had been completed on people's care records, daily logs and medication administration records. They had also completed regular observations on staff competency to deliver effective person-centred care. Some staff observations had not been recorded, however staff confirmed that these were carried out on a regular basis. We made a recommendation in relation to this.

People told us they felt they received care in a safe way. Individual risks to people and the environment had been identified and assessed and measures put in place to manage them and minimise the risk of harm occurring. Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm.

Medicines were managed safely by trained staff who ensured that people received medicines at the right time.

Sufficient numbers of suitably qualified and skilled staff were deployed to meet people's individual needs.

Staff had received a range of training and support to enable them to carry out their role safely. People told us they received the right care and support from staff who were well trained and competent at what they did.

Staff were motivated to deliver care in a person-centred way based on people's preferences and likes. Staff treated people with kindness, compassion and respect and ensured that people's dignity was maintained at all times.

People spoke positively about the care and support they received. People told us they received support from regular staff who knew them well. They told us staff always arrived on time and stayed the right amount of time.

People's needs and choices were assessed and planned for. Care plans identified intended outcomes for people and how they were to be met in a way they preferred. People received support to maintain good nutrition and hydration and their healthcare needs were understood and met.

Records relating to consent for care were accurately completed and people told us they were always offered choice and control over the care they received. Care was delivered in a personalised way which was in line with information recorded in people's care plans.

People and family members knew how to make a complaint and they were confident about raising concerns should they need to. They were confident that their complaint would be listened to and acted upon quickly.

The leadership of the service promoted person centred care and a positive culture within the staff team. People, family members and staff all described the registered manager as supportive and approachable.

The registered manager showed they were working hard to improve on the service and displayed knowledge and understanding around the importance of working closely with other agencies and healthcare professionals where needed.

Rating at last inspection:

Requires improvement (Report published 21 February 2018)

Why we inspected:

This was a planned comprehensive inspection based on the rating from the previous inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-

Inspection carried out on 12 December 2017

During a routine inspection

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 th

Inspection carried out on 10 January 2016

During a routine inspection

The inspection took place on 11, 12 and 13 January 2016. Tendring care is a domiciliary care agency (DCA) based in Essex which provides domiciliary care services predominately in Clacton on sea.

The service has a registered manager. 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.

There were systems in place which provided guidance for staff on how to safeguard the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

There were procedures and processes in place to ensure the safety of the people who used the service. People were safe because staff understood their responsibilities in managing risk. Where people required assistance to take their medicines there were arrangements in place to provide this support safely.

Staff respected people’s choices and took their preferences into account when providing support

There were sufficient staff who had been recruited safely and who had the skills and knowledge to provide care and support in ways that people preferred.

Training records for staff showed that essential training, covering a variety of topics, had been undertaken including induction training.

Staff members received regular supervisions; the manager told us annual appraisals would be conducted of care workers performance once they had worked at the service for one year. This showed that appropriate systems were in place to support staff to do their job.

There was a clear management structure in place which staff understood. Staff were aware of their role, responsibility and accountability in relation to the provision of services.

People told us they knew who and how to contact the service if they had a concern or complaint