Tender Hands Homecare Ltd

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

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

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 68 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Leaders and staff demonstrated a strong commitment to providing person-centred care and understood the importance of delivering support that reflected people's individual needs, preferences and choices. The provider knew the people they supported well and was passionate about ensuring people received high-quality care that met their needs and promoted positive outcomes.

People's needs, preferences and desired outcomes were clearly reflected within their care plans, which contained detailed information to guide staff in delivering personalised care and support.

However, we found that some other records, including daily care notes, were not always sufficiently detailed. This meant there was not always a clear account of the care and support provided or how people had responded to it. The provider had already identified this through their internal quality assurance processes, and we saw evidence that this had been discussed with staff to promote improvements in recording practices.

This demonstrated that the provider had systems in place to monitor the quality of records and was taking action to address areas identified for improvement.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders demonstrated a good understanding of the service, including its strengths, challenges and areas requiring further improvement. The provider was open and transparent when discussing aspects of the service that required development and was able to describe the actions taken to address identified concerns.

Where concerns or instances of poor practice had been identified, leaders took appropriate steps to investigate and address them. For example, issues were discussed through staff meetings and other management processes to support learning, improve practice and promote accountability.

The provider showed a willingness to reflect on the quality of the service and implement changes where necessary. This demonstrated a commitment to continuous improvement and to ensuring people received safe, effective and person-centred care.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

There were policies and procedures in place to support speaking up. People and staff told us they felt able to raise concerns and speak openly with the provider. There were regular touchpoints with staff, which provided opportunities for issues to be raised and discussed. However, there was little evidence to show how the feedback gathered from people and staff was used to drive continuous improvement within the service.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider worked in line with the Equality Act 2010 and promoted equality, diversity and inclusion within the service. Policies and procedures were in place to support equality of opportunity, prevent discrimination and ensure people received care in a fair, respectful and equitable manner. The provider employed a small but diverse staff team and recognised the value of different backgrounds, experiences and perspectives within the workforce.

Staff were encouraged to contribute their views and experiences through discussions, supervision sessions and other feedback opportunities. However,

there was no evidence staff received appraisal. This helped to promote an open culture where staff felt able to share suggestions and raise any concerns.

However, there was limited evidence to demonstrate how feedback from staff was routinely analysed and used to drive service improvements, enhance the quality of care or improve outcomes for people. We discussed this with the provider, who acknowledged the need to strengthen arrangements in this area. The provider confirmed that actions to improve the collection, analysis and use of staff feedback would be incorporated into their action plan to support continuous improvement and service development.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

There was a registered manager in place at the time of the assessment, who also acted as nominated Individual. They were actively involved and visible within the service. Oner relative told us, “Management are hands on and don’t act as superiors in a gilded cage.”

Governance systems and oversight arrangements were in place. However, these were not always effective. For example, quality assurance processes and audits did not identify shortfalls in the staff recruitment process, quality and detail of completed risk assessments or not working with the Mental Capacity Act. Completed audits were not always consistently comprehensive and lessons learnt were not always clearly identified or used to drive improvements. Whilst there was no evidence of harm to people using the service as a result of these shortfalls, governance systems need to be strengthened to ensure they identify areas for improvement and set out a clear pathway for development.

During the assessment we also reminded the registered manager of their responsibility to ensure all notifiable incidents were submitted to CQC in line with regulatory requirements. Following our feedback, leaders were receptive and took immediate steps to review their processes and strengthen oversight arrangements.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The provider developed links with a number of stakeholders and local community partners to ensure these relationships benefited people they supported.

The provider understood the value of involving others whose expertise and knowledge contributed to improving outcomes for people.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

There were processes and procedures in place to support a learning culture within the organisation. Leaders were able to describe how learning from incidents, complaints and concerns was shared within the service to help improve practice.

However, there was limited evidence to demonstrate how lessons learned were consistently recorded, monitored and used to drive improvement or positively influence outcomes for people. As a result, the provider could not always demonstrate the impact of learning on service development and quality improvement.

We also found completed audits and quality assurance checks were not always sufficiently detailed and lacked meaningful analysis. This limited the provider's ability to effectively identify trends, monitor performance and evidence improvements over time.

Following our feedback, the provider took proactive steps to review their governance and quality assurance systems. An action plan had been developed to strengthen auditing processes, improve the recording and analysis of learning, and enhance oversight of the service. This demonstrated a willingness to improve and a commitment to ensuring governance systems were effective in driving continuous improvement in the future.