Tender Hands Homecare Ltd

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.

This is the first assessment for this service. This key question has been rated 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. Staff 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.

Further work was needed to strengthen governance arrangements and ensure learning was fully embedded across the service. Although lessons learned were identified when things went wrong, records did not consistently demonstrate how learning from incidents, audits and other quality assurance processes had been documented, monitored and shared. In some cases, it was not clear what actions had been taken as a result of identified issues or how improvements had been sustained over time.

This meant the provider could not always evidence how information gathered through oversight activities was being used to drive continuous improvement, support organisational learning and enhance outcomes for people using the service.

The provider had policies and procedures in place to support organisational learning, quality assurance and continuous improvement.

Leaders were receptive to feedback and showed a willingness to make changes where required.

The provider 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. However not all of the systems of oversight were always effective.

People and staff knew how to raise and communicate concerns. One person told us, “I have not had to complain about anything, but I do know how to if I need to.”

People were consistently supported through safe systems, pathways and transitions. People had risk assessments in place. Some of the risk assessments were more comprehensive than the other. There was evidence staff worked well with people to manage risks in a proportionate manner, enabling them to lead as independent lives as possible.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The provider had policies and procedures in place designed to protect people from avoidable harm and to promote their safety and wellbeing. People and their relatives consistently told us they felt safe receiving support from the service and spoke positively about the care provided by staff.

Feedback from people and their relatives was overwhelmingly positive. One relative told us, “Oh yes, they feel more than safe with them all.” Another relative said, “My loved one feels safe and has a good rapport with all their careers.”

Staff completed safeguarding training. However, training records showed that not all staff were up to date with their safeguarding training at the time of the assessment. This meant the provider could not be fully assured that all staff had received current safeguarding training in line with its expectations.

Despite this finding, we did not identify any evidence that people had experienced harm or had been placed at risk as a result.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s risks assessments were completed and reviewed when required. However, some of the completed risk assessments were more comprehensive than others and further work was required to ensure that these were person-centred and comprehensive. For example, one person was at risk of developing pressure sores. However, this risk was not captured within their risk assessment. People told us they were involved in discussions about their care. One person told us,” I went through all the care needs with them [the provider] when we began. If anything needs changing, I just let the manager know. Recently we added a new cream to the list of my medicines due to issues with my skin.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Appropriate health, safety and environmental checks were carried out in people’s homes to help ensure the safety of both people and staff. These checks included checks on smoke and carbon monoxide alarms and inspecting equipment to confirm it was safe, fit for purpose and in good working order before use. This helped to minimise risks and promote a safe care environment.

The provider did not always make sure staff received adequate level of training to ensure they had right skills and knowledge to meet people’s needs. Staff did not always receive supervision and appraisal as per provider’s policy.

Recruitment processes needed strengthening to ensure that all necessary pre-employment checks were completed before staff commenced their roles. Records did not demonstrate appropriate references had always been obtained or right-to-work checks had been completed for all staff. In addition, where potential risks had been identified through the recruitment process, risk assessments needed enhancing to identify and mitigate those risks.

Although there was no evidence of harm to people using the service due to these shortfalls, we raised these concerns with the provider and advised that this area required review to ensure recruitment processes were safe and aligned with best practice.

There was evidence that staff received supervision to support them in their roles. However, records did not demonstrate this was carried out consistently for all staff. In addition, there was no evidence that annual appraisals had been completed. However, staff were supported and encouraged by the provider to speak up and share their feedback.

Training records showed not all staff were up to date with mandatory training. We were not assured the training provided was always sufficiently comprehensive to equip staff with the knowledge and skills required to meet people's needs safely and effectively. For example, moving and handling training had been delivered in one person's home by a staff member whose own moving and handling training was not up to date. This increased the risk of unsafe practice and could potentially place both staff and people receiving care at risk of harm or injury.

Following our initial feedback, the provider responded positively and took prompt action to address this concern. A senior member of staff was enrolled on a Train the Trainer moving and handling course to strengthen the provider's training arrangements and support the ongoing development and competency of staff. This demonstrated a willingness by leaders to learn from feedback and make improvements where concerns were identified.

There were enough staff deployed to meet people's needs safely and effectively. People received support from a consistent team of staff who knew them well and understood their individual needs and preferences. The provider sought to match staff with people to ensure theyfelt comfortable with the support they received and that their preferences were respected. One relative told us, “The reason we went with this agency was due to the fact they could provide my loved one with female carers. They guaranteed this which is what they wanted.”

People and their relatives spoke positively about staff and the care they provided. Staff were described as kind, compassionate and respectful in their approach. One relative told us, “Staff treat my loved one nicely and they seem happy with them.” Feedback indicated people had developed positive relationships with staff and felt comfortable receiving support from them.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There were appropriate policies and procedures in place to support the prevention and control of infection. Staff had access to personal protective equipment (PPE) and understood the importance of following infection prevention and control practices when providing care and support in people's homes.

The provider carried out checks and monitoring activities to help ensure staff adhered to infection prevention and control principles and followed expected practice. This provided oversight of staff performance and helped promote safe care delivery.

People and their relatives did not raise any concerns about infection prevention and control arrangements. They told us they felt safe receiving support in their own homes and where confident staff took appropriate measures to reduce the risk of infection. One person told us,” I see carers are wearing gloves and aprons when they visit.”

The systems in place supported the provider to reduce the risk of cross-infection and promote people's safety and wellbeing.

The provider did not always made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

We identified some areas where medicines records and documentation required improvement. Medicines Administration Records (MAR) did not always contain sufficiently detailed information to support the safe administration of medicines. For example, one person had been prescribed eye drops, but the records did not clearly specify which eye the medicine should be administered to. This meant staff may not always have access to complete instructions when supporting people with their medicines.

We also found that MAR charts did not consistently include important information about people's medicines and health needs, such as details of known allergies.

Although we did not identify any adverse impact on people and found no evidence that medicines had been administered unsafely, these recording omissions increased the risk of errors occurring and limited the effectiveness of the provider's medicines management systems.

We discussed our findings with the provider and told them to review their medicines management processes. This included ensuring medicines records were comprehensive,

accurate and person-centred, and provided staff with clear guidance to support the safe and effective administration of medicines. Following our feedback the provider developed an action plan to address these areas of improvement.

People who required support with their medicines were generally supported safely, and neither people nor their relatives’ raised concerns about the way medicines were managed. Feedback received indicated people were satisfied with the support provided by staff and felt confident their medicines were administered as required. One relative told us, “Staff supports my loved one with their medicines and they receive their medicines at the correct time. All of this is recorded on the app."