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Inspection carried out on 15 August 2019

During an inspection to make sure that the improvements required had been made

About the service

Tendacare is a domiciliary care service providing personal care to 122 people at the time of the inspection.

Why we inspected

We had previously carried out an unannounced comprehensive inspection of this service on 3 and 4 December 2018. Two breaches of legal requirements were found: Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good Governance and Regulation 18 of the CQC Registration Regulations 2009: Statutory Notifications.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. We undertook this focused inspection to check they had followed their action plan and to confirm they now met the legal requirements. This report only covers our findings in relation to the Well- Led Key Questions which contain those requirements.

The ratings from the previous comprehensive inspection for the other Key Questions were not looked at on this occasion. The overall rating for the service is now Good in every Key Question with no breaches of Regulation.

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

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

At the previous inspection, people were experiencing the delivery of good and safe care. This had continued, and we had no new concerns. The provider had addressed the need to clearly document people’s wishes and any consent issues.

People’s rights were protected and where people lacked the mental capacity to consent to care, the decision making process was now well recorded. The provider worked closely with people’s families, and those with legal authority, when any decisions were made in a person’s best interest.

People’s assessments now included an option to discuss their preferences for end of life care. This was done sensitively, and personal choice was always upheld. New records had been introduced to enable both essential and more personal information to be captured. This meant the service could demonstrate how they could be responsive in the event of illness or at end of life.

The service had a robust system for recording and reporting incidents, including the safeguarding of vulnerable adults. They had correctly notified the CQC of safeguarding concerns and they could evidence what actions were taken and how they involved the local authority to protect people from harm.

The service was well managed and there was good communication to support the smooth delivery of care. Improvements were being made, including the development of technology to support a more efficient service and to benefit people who received care. The service worked with other agencies to find people the support they needed and increase their health and wellbeing. There were established links and partnerships with other providers and local community services.

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 Good (published 16 January 2019). However, there were two breaches of Regulation found. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

Inspection carried out on 3 December 2018

During a routine inspection

About the service:

Tendacare is a domiciliary care agency that was providing personal care to 115 people aged 65 or over and 15 people aged under 65 at the time of the inspection.

People’s experience of using this service:

People who received care from Tendacare told us they felt safe and supported by staff who visited them. Staff were punctual and consistent at carrying out visits with people in a person-centred manner. One person told us, “I’m very happy with the service. They are friendly, efficient and on time.” People were supported to continue living at home in a way that enabled them to be as independent as possible.

Although there was evidence the service had provided good end of life care, there was no information in care plans about people’s preferences for their end of life care. Following the inspection the service arranged for people’s preferences to be recorded in their care plans.

The service was not always well managed as some records and documents had not been completed. The provider had also failed to notify CQC of safeguarding incidents. However, staff and people we spoke to all agreed that the service was well led. People, staff and relatives were involved in helping the service improve.

Care plans were created with people and relatives to ensure they were person centred and tailored to peoples’ needs and routines. Staff were trained and supported to be effective carers in a collaborative team. Where needed, staff were quick to support people to have access to health care professionals such as occupational therapists or, when necessary, emergency services. One relative told us, “I chose them because they are good at concentrated care and they feel like a very personal agency.”

People and relatives described staff as caring and kind towards them. Staff were approachable and friendly with people they cared for and knew them well.

More information can be seen in the main body of the report for each Key Question below.

Rating at last inspection:

Good (15 June 2016)

Why we inspected:

This was a scheduled comprehensive inspection. We inspect all services rated as 'Good' every 30 months to ensure that we regularly monitor and review the quality and safety of the service people receive.

Follow up:

Following the inspection the registered manager sent us evidence to demonstrate compliance with the Mental Capacity Act, up to date reviews of end of life care and notifications that should have be sent to CQC.

Inspection carried out on 22 April 2016

During a routine inspection

This was an announced inspection that took place on 22 April 2016.

The agency provides domiciliary care to people living in their own homes. It is located in the Ashtead, Surrey area.

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 and associated Regulations about how the service is run.

At the previous inspection in February 2014, the agency was compliant with regulations. At this inspection the regulations were met.

People told us they were happy with the service provided and were notified of changes to staff and the timing of care provided. The designated tasks were carried out to their satisfaction and the staff team really cared. They thought the service provided was safe, effective, caring, responsive and well led.

The records were kept up to date and covered all aspects of the care and support people received, their choices and identified and met their needs. They contained clearly recorded, fully completed, and regularly reviewed information that enabled staff to perform their duties.

Staff where knowledgeable about the people they gave support to and the way people liked to be supported. They also worked well as a team when it was required, such as calls that may require two staff members. Staff provided care and support in a professional, friendly and supportive way that was focussed on the individual and they had appropriate skills to do so. They were well trained, knowledgeable and accessible to people using the service and their relatives. Staff said the organisation was a good one to work for and they enjoyed their work. They had access to good training, support and there were opportunities for career advancement.

People and their relatives were encouraged to discuss health and other needs with staff and had agreed information passed on to GP’s and other community based health professionals, as appropriate. Staff protected people from nutrition and hydration associated risks by giving advice about healthy food options and balanced diets whilst still making sure people’s meal likes, dislikes and preferences were met.

The agency staff knew about the Mental Capacity Act and their responsibilities regarding it.

People told us the office, management team and organisation were approachable, responsive, encouraged feedback and frequently monitored and assessed the quality of the service provided.

Inspection carried out on 17 February 2014

During a routine inspection

We spoke with eleven people or their representatives who use the service. One person told us, “they were very happy with the service, the staff were very professional and well trained”. Another person told us “they were really satisfied with the service and would recommend it to anyone”.

We noted that people's consent was obtained where possible before care was undertaken. One person told us “the carer always asked what they wanted and ensured they had choice”.

We found that the care given was safe and appropriate and based on effective care planning and risk assessments. We sampled fourteen care records and noted the risk assessments and care plans were person focussed and preferences taken into account. One person told us “the carers were so good at picking up on changes and there was good communication between the provider and themselves”.

People were protected from the risks associated with poor medication management. We noted medicines were properly handled and administered in line with the provider's policy.

Appropriate checks were undertaken before staff began work and there were effective recruitment and selection processes in place. We sampled five staff records and spoke with five staff. One person told us they were “always provided with very good experienced staff”.

The provider regularly monitored and reviewed the quality of its service. One person told us about "good communication and they could make changes at any time or raise any issues".

Inspection carried out on 5 February 2013

During a routine inspection

The agency had policies and procedures in place that ensured people’s needs and wishes were assessed and recorded prior to them receiving care. A relative told us “We work as a team together and there is regular communication with the staff”.

People’s needs and wishes were recorded in a plan of care and these incorporated an assessment of risks to people’s safety. We saw evidence that these were reviewed regularly.

In order to protect the people using the service, there was a robust recruitment policy in place and all new staff received safeguarding training during induction. Regular refreshers were in place for all staff.

Staff received ongoing training and support, which provided them with the skills and knowledge to meet the needs of the people they were supporting. Observational techniques and mentoring were used, to ensure staff carried out their roles appropriately.

People that we spoke with were very positive about the staff team and comments included, “they provide a good quality of care”, “we are happy with the service” and “we have used them for years and never found fault with them”.

There were processes in place to monitor the quality of service being provided and we saw that people were involved through questionnaires and spot checks. People we spoke to said that changes were made when any issues had been raised with the agency.

Inspection carried out on 2 February 2012

During a routine inspection

People who use the service and their relatives told us they were involved in making decisions about the care and support they or their relative received, and felt they were well supported by the agency. They told us that they were happy with the personal care that staff provided and felt their privacy and dignity was respected. People using the service said they felt safe and secure with their carers. They knew most of them very well and had found them to be both professional and experienced in meeting their needs. Relatives and advocates said they had developed good working relationships with the manager and other senior agency staff, which clearly benefited them and the people using the service. Two people mentioned that the manager and her deputy still continue to work ‘hands on’ when possible, which gave them the opportunity to regularly assess and monitor the quality of the service they offer to people. One person using services told us, “The agency provides complete care and total satisfaction.”