Archived: TenderCare 4 You

This service 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 to older adults.

Not everyone using TenderCare 4 You receives regulated activity; 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 our inspection four people were receiving support from the service.

There was a registered manager in post at the time of our inspection. 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.

We found a breach of the regulations in relation to good governance.

Quality assurance systems required improvement to ensure that the content and period of time the review covered was clear. Following the inspection, we were sent an updated template that the provider told us they would implement with immediate effect.

The registered manager had not ensured that quality assurance systems operated effectively and we need to be sure that any improvements could be sustained over a period of time.

At this inspection we found that improvements were needed in relation to staff recruitment processes. Staff records did not always include complete references or the staff member’s employment history, and we were unable to find proof of identify for two staff members. Following the inspection the provider took action to chase up these documents and sent us an updated application form to reflect people’s employment history.

Records did not reflect that people’s risk assessments and care plans were always reviewed on a regular basis. The registered manager had not always been available to ensure these tasks were completed, however he had not delegated these tasks to ensure that risk assessments and care plans were up to date. We were assured that action would be taken to review each person’s risk assessments and care plan following the inspection.

Staff did not always receive regular training, supervision or appraisal. The registered manager had not always been available to conduct these meetings, and despite regular phone contact had not recorded regular supervision sessions with staff. However, staff were satisfied that the registered manager was available to them.

We have made a recommendation in relation to the personalisation of people’s care plans, to ensure people’s preferences are reflected.

People’s medicines were safely managed, and staff knew how to ensure people received their medicines on time. Staff took appropriate steps to manage infection control when working in people’s homes. Any incidents and accidents were appropriately investigated and recorded.

Staff that we spoke with were not always clear on the principles of the Mental Capacity Act (MCA) 2005 and how this applied to their roles. These staff had not kept up to date with their training, and the provider ensured another refresher training session was booked.

People were supported to eat and drink where necessary, and supported to access other healthcare professionals at times that they needed to.

Staff treated people with kindness and compassion, and were passionate about their work. People and where necessary, their family members were supported to make decisions about the support and day to day care they received. Staff demonstrated that they treated people with dignity and respect, whilst supporting them to remain as independent as they were able to.

People’s end of life wishes needed to be fully reflected within people’s care records. Following the inspection, an updated form was implemented to express these views.

A complaints policy was in place to ensure people were supported to express any concerns. There had been no complaints raised since our last inspection.

The registered manager told us they were aware of improvements that were required in the running of the service. Staff and relatives were confident in the support they received from the registered manager and found him to be approachable. The registered manager was clear on their responsibilities to the CQC and had notified us of important events.

The service had 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.

We carried out an unannounced comprehensive inspection of this service on 13 June 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for TenderCare 4 You on our website at www.cqc.org.uk

At the last inspection on 13 June 2016 the registered manager had not sent the Care Quality Commission (CQC) notifications of safeguarding allegations that took place at the service. This was a breach of Regulation 18 notification of other incidents of the Health and Social Care Act 2008 (Registration) Regulations 2014.

We then carried out an announced focussed inspection on 1 March 2017. We did not look at all of the key lines of enquiry under each key question. We looked at the questions, is this service well-led? We followed up on the breach of regulation to see if the registered provider had made improvements to the service. We found the registered manger had taken action to improve the service to meet legal requirements in relation to that breach of regulation.

At this inspection, we found the registered manager had informed CQC of incidents at the service. When a safeguarding incident occurred at the service this was reported to the local authority. A notification was also sent to CQC of each safeguarding allegations.

The service had met standards of quality and safety at our last inspection which was carried out on 29 July 2014.

This inspection took place on 13 June 2016. 24 hours before the inspection we contacted the service to let know that we would be coming to inspect them. We wanted to make sure that someone would be in the office on the day of inspection.

At the time of the inspection the service had a registered manager. A registered manager is a person who has registered with the 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 2008 and associated Regulations about how the service is run.

At this inspection we found that the service had not sent the CQC notifications. A notification is information about important events which the service is required to send us by law. This was a breach of Regulation 18 of CQC (Registration) Regulations 2009.

People felt they had their needs met safely. Staff had awareness of potential signs of abuse to people and supported people to minimise the risks identified. However, the risk assessments did not assess the likelihood and severity of the potential risks to people. This meant the staff team was not aware of the level of risks to people. The service followed the accidents and incidents procedure to ensure that people had the support required to manage the increased risks. There were enough staff to meet people's care needs. People received support to have their medicines safely and as prescribed .

Staff had support to develop within their role that enabled them to provide effective care for people. They attended relevant training courses, which ensured they were up-to-date with the knowledge required for their role. The service carried out regular supervisions to ensure that staff had sufficient skills to support people with their needs. The registered manager was in the process of planning appraisal meetings for staff that were working for the service for less than a year. People were assisted to eat and drink as they chose to. Staff supported people to attend to their health needs as and when required.

Staff were not provided with a Mental Capacity Act 2005 (MCA) training. So we could not be assured that the MCA principles were followed when staff assessed people’s capacity to make decisions. The registered manager booked the MCA training course for staff on the day of inspection.

People felt that staff were kind and compassionate. Staff were aware of people’s preferences and helped them to maintain routines that were important for them. People got to know staff before they started supporting them, which meant that people were provided with choices as to who provided support. People told us their privacy was respected. People’s relatives shared their experiences with the service to ensure that people’s care needs were met as required.

People told us they were provided with care that met their needs. Regular review meetings were carried out, which ensured that people were involved in making decisions about their care. At the time of inspection, people and their relatives did not have any complaints about the support provided. Information was available to people on how to complain. The service had obtained people’s feedback on the care they received and addressed the issues identified as necessary.

Staff received support from the management team. The registered manager provided guidance and advice to the staff when necessary. Staff were encouraged to take initiative and share their ideas to improve service delivery for people. Regular audits took place to ensure the quality of the services provided for people. The registered manager carried out individual checks on staff to review their performance and to improve the care delivery.

Due to the nature of our concerns at our previous inspection we did not speak to any people using the service or additional staff. At our previous inspection people using the service were happy with the care they received and staff felt supported by their manager.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what the manager told us and what we observed from the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Care records contained instructions to staff about how people wished to be supported with their medicines. Medicines were only administered by staff who had received the training to do so safely.

Safeguarding processes had been updated and a new reporting form had been introduced to ensure all allegations of abuse were recorded, reported and investigated appropriately.

Is the service effective?

Staff received or were booked onto training courses to ensure they had the knowledge and skills to meet people's needs.

Is the service caring?

This question was not inspected during this follow up inspection.

Is the service responsive to people's needs?

Care plans and risk assessments had been updated to ensure they detailed how and when people wished to be supported.

Is the service well-led?

The manager had introduced systems to check the quality of service provision and undertook monthly spot checks.

The manager ensured all staff were informed about what was required to be notified to the Care Quality Commission.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People who used the service told us they felt safe. A relative told us the manager kept them informed of any changes or concerns regarding a person's health.

Staff were knowledgeable in recognising signs of abuse. However, there was no evidence that staff had received updated training in safeguarding vulnerable adults. The service's safeguarding policy was out of date and did not provide staff with information about how to report a concern to the local authority's safeguarding team. Allegations of abuse had not been reported to the local authority or to the Care Quality Commission as required.

Is the service effective?

People and their relatives were happy with the service provided. Staff were able to describe people's support needs, and were aware of what aspects of care people were able to do for themselves. However, we did not see evidence of formal assessments of people's needs and there was a lack of detail and information in people's care plans. The care plans we reviewed lacked information on what support people required, what medication they were taking, and any illnesses or allergies they had. This meant there was a risk that people were not being supported in line with their individual needs, and their safety and welfare was not being maintained.

There was no evidence that staff had received the required refresher training which meant there was a risk that they didn't have the updated knowledge and skills to support people with their care and support needs.

Is the service caring?

One person who used the service told us the staff were 'thoughtful and attentive' and 'they're very good.' People, and their relatives, felt involved in decisions about their care and they felt listened to.

Is the service responsive to people's needs?

People told us the staff attended at the times and on the days they were meant to. They said the staff undertook the duties they requested them to and felt staff responded to their needs. We saw that any changes in the support people required was communicated to the person's next of kin and the manager of the service to ensure the service provided met people's current needs.

There was a process in place for reporting complaints and people felt able to raise any concerns with the manager of the service.

Is the service well-led?

Staff felt well supported and listened to by the manager of the service. They said the manager was responsive to any requests and they felt involved in decisions about the care provided to the people they supported.

The manager undertook spot checks to review the quality of the service provided but this was not formally recorded, and there was a risk that concerns in performance may not be addressed. The manager told us there was a process for recording incidents but at the time of our inspection this was not in use, meaning there was a concern that some incidents may not be adequately responded to and the service was unable to identify any trends in incidents.

Care was planned and delivered to meet the needs of people using the service. Each person had a care plan which was regularly reviewed.

Staff demonstrated knowledge of safeguarding procedures and in recognising signs of potential abuse.

There were effective recruitment processes and appropriate checks were undertaken before staff started work. An induction process was in place to support new employees which included shadowing senior members of staff and undertaking a competency assessment.

Staff had weekly contact with the manager of the service and a formal supervision process was being set up. The service was setting up a process in which to deliver refresher training on safeguarding vulnerable adults, administration of medication and manual handling to all staff.

The manager undertook weekly spot checks to ensure the quality of service provision. People using the service were asked for their views on service delivery through contact with the manager and through completion of formal satisfaction surveys.

Care and support was tailored to the individual. People told us they felt well supported and involved in identifying their support needs. One person told us, 'I couldn't wish for a better service.'

Care plans covered all aspects of care provided and considered the physical, mental, financial and emotional support needs of people using the service.

Staff demonstrated knowledge of identifying and reporting safeguarding concerns, but there was no record of staff attending protection of vulnerable adults training or evidence of disclosure and barring service checks being undertaken.

No formal recruitment and selection processes were recorded.

The manager of the service regularly undertook spot checks to assess the quality of service provision.