Tender-Care Services Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has change to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. They did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice. The provider had an electronic system to record incidents and accidents. However, the registered manager did not have effective oversight and auditing of accidents and incidents to support learning, identify trends, and drive for improvement. This meant opportunities to identify patterns, promote learning, and reduce potential risks may have been missed. Staff understood their responsibilities to report any accidents and incidents and recognised the importance of informing the registered manager when these occurred. Staff, people, and relatives told us they felt confident raising concerns, and relatives said they were kept informed of any changes.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. People were supported with contact from external health professionals as required, such as the GP. There was an electronic system to share essential information with the necessary health and social care professionals. This included information for an emergency admission to hospital. A staff member said, “We work with the district nurses, the pharmacists and paramedics. We regularly contact district nurses for certain clients that need dressing changes, catheters. We are also in contact with the pharmacy, to order medication so that the clients don’t run out.”

The service did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. They did not always share concerns quickly and appropriately. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In community settings, including domiciliary care services, any restrictions placed on a person's liberty must be assessed and authorised through the appropriate legal framework. We checked whether the service was working within the principles of the MCA, whether people's capacity had been appropriately assessed, whether restrictions on people's liberty were necessary and proportionate, and whether any conditions relating to legal authorisations were being met. We found the registered manager did not have effective oversight of people subjected to restrictive practices or legal authorisations. This meant there was a risk that people could be subject to restrictions without appropriate legal authorisation or safeguards being in place. However, staff ensured people were protected from harm. Staff told us how they would raise concerns both within the service and externally. There was evidence of safeguarding referrals being made appropriately, and the provider had received positive feedback from the local authority regarding their response to reported incidents.

The service did not always work well with people to understand and manage risks. They did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.We were not assured that all risk mitigation plans were in place for known risks, or that plans provided adequate guidance for staff to manage identified risks. For example, 1 person who required support with their Percutaneous Endoscopic Gastrostomy (this is a feeding tube inserted directly into the stomach to provide nutrition, fluids, and medications when a person cannot eat or drink enough by mouth.) did not have sufficient guidance in relation to the risks associated with this. While staff were aware of risks relating to the person's health and wellbeing needs, care records did not always clearly demonstrate how these risks were assessed and managed to support the person safely. This meant the provider could not be assured that risks were being effectively assessed, communicated, and managed.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.The service detected and controlled potential risks in the care environment. Environmental risk assessments and considerations were in place for people’s care and support. Staff had received training on using equipment correctly, for example, equipment used to help people move around their home.

The service did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs. Staff received an induction and a set of mandatory training courses before they begun work. This included face to face moving and handling training and medication training, and these were followed up with a competency assessment to ensure their practice was safe. However, the provider did not ensure that staff training compliance remained safe, and we found that some staff had multiple mandatory training courses that had expired. This meant staff knowledge may not be current, and their practice may have deteriorated. Procedures were in place to ensure the required checks were completed prior to staff commencing their employment. This included enhanced Disclosure and Barring Service (DBS) checks for adults. DBS checks provide information including details about convictions and cautions held on the police national computer. The information helps employers make safer recruitment decisions.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.Staff had access to the correct personal protective equipment as needed and supplies were available to them. People and relatives told us staff always wore aprons and gloves throughout their care visit. Records showed staff had received training for infection prevention and control.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They did not always involve people in planning.We found that where people had support from the provider with their medication management and administration, risk assessments were not robust. Where medicines were prescribed to be taken ‘when required’ (PRN) there was not always personalised protocols or anything of a similar nature that instructed staff on when and how to administer these, additionally, how long someone could take a PRN medication for before they needed to access a health professional for review. We also found medication administration records lacked important detail. The provider responded immediately by reviewing and updating all medication administration records and was looking at creating new PRN protocols.